Home About us Contact
|
Home About us Contact | ||
|
|
||
Fatal
Terms modified by Fatal Selected AbstractsVENOUS NEEDLE DISLODGEMENT: HOW TO MINIMISE THE RISKSJOURNAL OF RENAL CARE, Issue 4 2008Jean-Pierre Van Waeleghem SUMMARY Although haemodialysis (HD) has become a routine treatment, adverse side effects, and occasionally life threatening clinical complications, still happen. Venous needle dislodgment (VND) is one of the most serious accidents that can occur during HD. If the blood pump is not stopped, either by activation of the protective system of the dialysis machine or manually, the patient can bleed to death within minutes. Fatal and near-fatal blood loss due to VND have been described in the literature (ECRI 1998; Sandroni 2005; Mactier & Worth 2007), but published reports represent only the tip of the ice berg, as such incidents are normally handled at a local or national level. The European Dialysis and Transplant Nurses Association/European Renal Care Association (EDTNA/ERCA) has produced 12 practice recommendations to help reduce the risk of VND and detect blood leakage as early as possible. A poster summarising these recommendations has been created (Van Waeleghem et al. 2008). [source] Fatal and Nonfatal Severe Jellyfish Stings in Thai WatersJOURNAL OF TRAVEL MEDICINE, Issue 2 2010FACTM, FRCGP, MD (London), Peter J. Fenner AM First page of article [source] The Sin of Asyndeton: Fatal, Flaws in Enriching our WorshipTHE HEYTHROP JOURNAL, Issue 4 2000J. Barrington Bates First page of article [source] Structural Model Updating and Health Monitoring with Incomplete Modal Data Using Gibbs SamplerCOMPUTER-AIDED CIVIL AND INFRASTRUCTURE ENGINEERING, Issue 4 2006Jianye Ching It is based on the Gibbs sampler, a stochastic simulation method that decomposes the uncertain model parameters into three groups, so that the direct sampling from any one group is possible when conditional on the other groups and the incomplete modal data. This means that even if the number of uncertain parameters is large, the effective dimension for the Gibbs sampler is always three and so high-dimensional parameter spaces that are fatal to most sampling techniques are handled by the method, making it more practical for health monitoring of real structures. The approach also inherits the advantages of Bayesian techniques: it not only updates the optimal estimate of the structural parameters but also updates the associated uncertainties. The approach is illustrated by applying it to two examples of structural health monitoring problems, in which the goal is to detect and quantify any damage using incomplete modal data obtained from small-amplitude vibrations measured before and after a severe loading event, such as an earthquake or explosion. [source] Management of a Fetal Intrapericardial Teratoma: A Case Report and Review of the LiteratureCONGENITAL HEART DISEASE, Issue 1 2010Angela M. Fagiana MD ABSTRACT Intrapericardial teratomas are rare but potentially fatal. With prenatal ultrasound, early diagnosis and decision for treatment can be accomplished. However, the decision becomes to treat prenatally vs. waiting until the neonatal period for definitive surgical management. The most common sequelae of intrapericardial teratomas are pericardial effusion and often progression to hydrops. It is these sequelae that tend to guide management. Presented here is a case report of the diagnosis and management of a twin fetus with an intrapericardial teratoma, as well as a review of the literature. [source] A comparison of offenders with intellectual disability across three levels of securityCRIMINAL BEHAVIOUR AND MENTAL HEALTH, Issue 1 2006Todd Hogue Background,A number of authors have described, with disparate results, the prevalence of people with intellectual disability and their characteristics, in a range of offender cohorts defined by service use. These have included high security, a range of criminal justice services and community services. There is a need for research comparing cohorts of offenders with intellectual disabilities across different settings. Aim and hypothesis,To conduct such a comparison and test the hypothesis that severity of characteristics measured will be highest in highest levels of residential security. Method,A clinical-record-based comparison a offenders with intellectual disability in high security (n = 73), medium/low security (n = 70), and a community service (n = 69). Results,Groups were similar in age and tested IQ levels. Early psychiatric service contact had been more likely in the lower security groups. In line with the hypothesis, more complex presentations, in particular comorbid personality disorder, was more likely in the highest security group. Both fatal and non-fatal interpersonal violence convictions were significantly related to group, with more in the high security group sustaining a conviction both at the index offence and prior to that. Over 50% of all groups had at least one conviction for a sexual offence. A regression model accounting for 78% of the variance was made up largely of disposal variables (Mental Health Act status and probation) and indications of antisocial traits (criminal damage, lifetime conviction for murder and ICD-10 personality disorder classification). Conclusions and implications for practice,The authors show that context of sampling affects most relationships between intellectual disability (ID) and offending when the methods for measuring ID are held constant. The results also present several questions on the relationship between risk, services available in an area and referral to higher security. Copyright © 2006 John Wiley & Sons, Ltd. [source] Malignant Glomus Tumor: A Case Report and Review of the LiteratureDERMATOLOGIC SURGERY, Issue 9 2001John D. Kayal MD Glomangiosarcoma, or malignant glomus tumor, is a very rare neoplasm that when seen typically arises from a benign glomus tumor. Despite having histologic features of malignancy, these tumors usually do not metastasize. However, when metastasis occurs this disease is often fatal. We report a case of a malignant glomus tumor arising de novo on the nose of an 89-year-old white woman, and we review the literature concerning glomangiosarcomas. [source] Necrotizing vasculitis in a patient affected by autoimmune hyperthyroidism treated with propylthiouracilDERMATOLOGIC THERAPY, Issue 2010Angela Antonucci ABSTRACT Necrotizing vasculitis is a complex phenomenon because of an inflammation of small and larger vessels with polymorph infiltration within the vessel walls and leukocytoclasis, occurring in several autoimmune diseases. Propylthiouracil (PTU) is a medication commonly used to treat hyperthyroidism, but it is associated with various rare side effects, such as antineutrophil cytoplasm antibody-positive vasculitis. In the last decades, multiple cases of PTU causing antineutrophilic cytoplasmic antibody have been reported, some of them fatal. The present authors report the case of a 34-year-old Caucasian female affected by autoimmune hyperthyroidism treated with PTU, presenting an antineutrophil cytoplasm antibody-positive necrotizing vasculitis, with high levels of anticardiolipin antibodies that involved the upper arms and buttocks. The clinical manifestations improved after discontinuing of PTU and immunosuppressant treatment. [source] Lumps and bumps in neonates and infantsDERMATOLOGIC THERAPY, Issue 2 2005Davis Farvolden ABSTRACT:, There are many developmental abnormalities that may appear in the neonate and in infants when critical steps in embryogenesis fail. These steps are often not fatal but can lead to signifi-cant morbidity for those patients affected. A logical approach is needed in addressing both the diagnostic and therapeutic issues that arise when caring for these patients, as various lesions will warrant an observational approach, and others may require imaging studies or definitive surgical intervention. Additionally, there are other "lumps and bumps" that are seen in the neonatal and infantile age groups that include malignancies and cutaneous neoplasms with associated systemic sequelae. [source] Intracerebral large artery disease in Aicardi,Goutières syndrome implicates SAMHD1 in vascular homeostasisDEVELOPMENTAL MEDICINE & CHILD NEUROLOGY, Issue 8 2010VENKATESWARAN RAMESH Aim, To describe a spectrum of intracerebral large artery disease in Aicardi,Goutières syndrome (AGS) associated with mutations in the AGS5 gene SAMHD1. Method, We used clinical and radiological description and molecular analysis. Results, Five individuals (three males, two females) were identified as having biallelic mutations in SAMHD1 and a cerebral arteriopathy in association with peripheral vessel involvement resulting in chilblains and ischaemic ulceration. The cerebral vasculopathy was primarily occlusive in three patients (with terminal carotid occlusion and basal collaterals reminiscent of moyamoya syndrome) and aneurysmal in two. Three of the five patients experienced intracerebral haemorrhage, which was fatal in two individuals. Post-mortem examination of one patient suggested that the arteriopathy was inflammatory in origin. Interpretation, Mutations in SAMHD1 are associated with a cerebral vasculopathy which is likely to have an inflammatory aetiology. A similar disease has not been observed in patients with mutations in AGS1 to AGS4, suggesting a particular role for SAMHD1 in vascular homeostasis. Our report raises important questions about the management of patients with mutations in SAMHD1. [source] Residual risk for acute stroke in patients with type 2 diabetes and hypertension in primary care: Skaraborg Hypertension and Diabetes ProjectDIABETES OBESITY & METABOLISM, Issue 5 2006K. Junga Aim:, The aim of this study was to investigate the risk of acute stroke in subgroups of patients treated for hypertension and type 2 diabetes in primary care. Methods:, Patients with hypertension only (n = 695), type 2 diabetes only (n = 181) or both (n = 240), who consecutively attended an annual control in primary care in Skara, Sweden during 1992,1993, were evaluated for cardiovascular disease risk factors and enrolled in this study. Subjects with neither hypertension nor type 2 diabetes (n = 824) who participated in a population survey in the same community served as controls. Possible events of acute stroke through 2002 were validated using hospital records and death certificates. Results:, During a mean follow-up time of 8.4 years, 190 first events of acute stroke, fatal or non-fatal, were ascertained. Risk factor levels were generally higher in all patient categories than in controls. Stroke risk was significantly increased in all male patients: hazard ratio 4.2 (95% CI 2.1,8.4) in patients with both conditions, 3.3 (1.5,7.0) in those with type 2 diabetes alone and 2.8 (1.5,5.3) in those with hypertension alone (adjusted for age, total cholesterol, current smoking, BMI and physical activity). Corresponding findings in women were 2.9 (1.5,5.8) in patients with type 2 diabetes only and 2.4 (1.2,4.7) in those with both conditions. However, in women with hypertension only, a significant risk was seen first when subjects were truncated at 85 years of age. There were too few fatal stroke events for conclusive results on stroke mortality. Conclusions:, A considerable risk of acute stroke remains in patients with type 2 diabetes and hypertension. Strategies for stricter multiple risk factor interventions should be implemented in primary care. [source] Surviving atlanto-occipital dislocationEMERGENCY MEDICINE AUSTRALASIA, Issue 4 2007Benjamin M Bloom Abstract Traumatic atlanto-occipital dislocation carries a significant mortality and morbidity. We present the clinical and radiological features of a case of traumatic skeletal and central nervous system disunion. Thanks to a combination of early resuscitation and luck, the patient survived an improbably severe injury to leave hospital and enjoy a degree of independent life. Such severe injuries are usually fatal and the literature on such extensive cervical disruption is often confined to postmortem evidence. [source] Cold hardiness of diapausing and non-diapausing pupae of the European grapevine moth, Lobesia botranaENTOMOLOGIA EXPERIMENTALIS ET APPLICATA, Issue 2 2005Stefanos S. Andreadis Abstract Lobesia botrana (Denis & Schiffermüller) (Lepidoptera: Tortricidae) is a key pest of grapes in Europe. It overwinters as a pupa in the bark crevices of the plant. Supercooling point (SCP) and low temperature survival was investigated in the laboratory and was determined using a cool bath and a 1 °C min,1 cooling rate. Freezing was fatal both to diapausing and non-diapausing pupae. SCP was significantly lower in diapausing male (,24.8 °C) and female (,24.5 °C) pupae than in non-diapausing ones (,22.7 and ,22.5 °C, respectively). Sex had no influence on SCP both for diapausing and non-diapausing pupae. Supercooling was also not affected by acclimation. However, acclimation did improve survival of diapausing pupae at temperatures above the SCP. Survival increased as acclimation period increased and the influence was more profound at the lower temperatures examined. Diapausing pupae could withstand lower temperatures than non-diapausing ones and lethal temperature was significantly lower than for non-diapausing pupae. Freezing injury above the SCP has been well documented for both physiological stages of L. botrana pupae. Our findings suggest a diapause-related cold hardiness for L. botrana and given its cold hardiness ability, winter mortality due to low temperatures is not expected to occur, especially in southern Europe. [source] Chronic toxicity and responses of several important enzymes in Daphnia magna on exposure to sublethal microcystin-LRENVIRONMENTAL TOXICOLOGY, Issue 3 2005Wei Chen Abstract In the current study, the toxicological mechanisms of microcystin-LR and its disadvantageous effects on Daphnia magna were examined. Survival rate, number of newborn, activity of several important enzymes [glutathione S-transferase (GST), lactate dehydrogenase (LDH), phosphatases, and glutathione], accumulated microcystins, and ultrastructural changes in different organs of Daphnia were monitored over the course of 21-day chronic tests. The results indicated that low concentrations of dissolved microcystin had no harmful effect on Daphnia. On the contrary, stimulatory effects were detected. In the presence of toxin at high dosage and for long-term exposure, GST and glutathione levels decreased significantly. The decreased enzyme activity in the antioxidant system probably was caused by detoxification reactions with toxins. And these processes of detoxification at the beginning of chronic tests may enable phosphatases in Daphnia magna to withstand inhibition by the toxins. At the same time, we also found that the LDH activity in test animals increased with exposure to microcystin-LR, indicating that adverse effects occurred in Daphnia. With microcystin given at a higher dosage or for a longer exposure, the effect on Daphnia magna was fatal. In the meantime, microcystin began to accumulate in Daphnia magna, and phosphatase activity started to be inhibited. From the ultrastructure results of cells in D. magna, we obtained new information: the alimentary canal may be the target organ affected by exposure of microcystins to D. magna. The results of the current study also suggested that the oxidative damage and PPI (protein phosphatase inhibition) mechanisms of vertebrates also are adapted to Daphnia. © 2005 Wiley Periodicals, Inc. Environ Toxicol 20: 323,330, 2005. [source] Effects of a sustained heroin shortage in three Australian StatesADDICTION, Issue 7 2005Louisa Degenhardt ABSTRACT Background In early 2001 in Australia there was a sudden and dramatic decrease in heroin availability that occurred throughout the country that was evidenced by marked increases in heroin price and decreases in its purity. Aim This study examines the impact of this change in heroin supply on the following indicators of heroin use: fatal and non-fatal drug overdoses; treatment seeking for heroin dependence; injecting drug use; drug-specific offences; and general property offences. The study was conducted using data from three Australian States [New South Wales (NSW), Victoria (VIC) and South Australia (SA)]. Methods Data were obtained on fatal and non-fatal overdoses from hospital emergency departments (EDs), ambulance services and coronial systems; treatment entries for heroin dependence compiled by State health departments; numbers of needles and syringes distributed to drug users; and data on arrests for heroin-related incidents and property-related crime incidents compiled by State Police Services. Time-series analyses were conducted where possible to examine changes before and after the onset of the heroin shortage. These were supplemented with information drawn from studies involving interviews with injecting drug users. Results After the reduction in heroin supply, fatal and non-fatal heroin overdoses decreased by between 40% and 85%. Despite some evidence of increased cocaine, methamphetamine and benzodiazepine use and reports of increases in harms related to their use, there were no increases recorded in the number of either non-fatal overdoses or deaths related to these drugs. There was a sustained decline in injecting drug use in NSW and VIC, as indicated by a substantial drop in the number of needles and syringes distributed (to 1999 levels in Victoria). There was a short-lived increase in property crime in NSW followed by a sustained reduction in such offences. SA and VIC did not show any marked change in the categories of property crime examined in the study. Conclusions Substantial reductions in heroin availability have not occurred often, but in this Australian case a reduction had an aggregate positive impact in that it was associated with: reduced fatal and non-fatal heroin overdoses; reduced the apparent extent of injecting drug use in VIC and NSW; and may have contributed to reduced crime in NSW. All these changes provide substantial benefits to the community and some to heroin users. Documented shifts to other forms of drug use did not appear sufficient to produce increases in deaths, non-fatal overdoses or treatment seeking related to those drugs. [source] Fulminant hepatitis after allogenic bone marrow transplantation caused by reactivation of hepatitis B virus with gene mutations in the core promotor regionEUROPEAN JOURNAL OF HAEMATOLOGY, Issue 3 2006Kiyoshi Kitano Abstract:, Under immunosuppressive conditions after hematopoietic stem cell transplantation (HSCT), even if hepatitis B virus (HBV) antigen is negative but hepatitis B surface antibody (HBsAb) or hepatitis B core antibody (HBcAb) is presented, HBV reactivates and sometimes causes fulminant hepatitis. However, it remains unclear which patients will develop fulminant hepatitis, or whether fulminant hepatitis is caused by host-related factors or by virus-related factors. A 30-yr-old man with a history of aplastic anemia since 3 yr of age underwent allogenic BMT, when HBsAb and HBcAb were positive but HBs antigen (HBsAg) was negative. The donor was negative for HBsAg, HBsAb and HBcAb. After transplantation, the patient was complicated by acute graft-vs.-host disease (GVHD), cytomegalovirus infection, intestinal thrombotic microangiopathy and aspergillus colitis. Chronic GVHD was well controlled by FK506 and prednisolone. Twenty months after transplantation, the patient was admitted with general fatigue and liver dysfunction and was found to be positive for HBsAg and HBeAg. His serum HBV-DNA level was >8.8 log of the genome equivalent (LGE)/mL. Therefore, he was diagnosed as having hepatitis B caused by HBV reactivation and 100 mg/d lamivudine treatment was started. However, jaundice and hepatic failure deteriorated and became fatal. On analysis of the HBV-DNA, two adjacent gene mutations in the core promoter region (T1762/A1764) were detected. Increased replication of the mutated HBV might have caused HBV reactivation which progressed to fulminant hepatitis. [source] Congenital asplenia and group B streptococcus sepsis in the adult: case report and review of the literatureFEMS IMMUNOLOGY & MEDICAL MICROBIOLOGY, Issue 3 2008Kumaran Thiruppathy Abstract Asplenia is associated with an increased incidence of fatal and life-threatening sepsis caused by encapsulated pathogens. Isolated congenital asplenia is a very rare condition, with only 33 cases reported in the literature. The authors report another case of this condition complicated by overwhelming Group B streptococcus sepsis secondary to paronychia that was managed successfully. [source] Gemcitabine-induced severe pulmonary toxicityFUNDAMENTAL & CLINICAL PHARMACOLOGY, Issue 1 2004Fabrice Barlési Abstract Gemcitabine is a relatively new deoxycytidine analog (2,,2,-difluorodeoxycytidine) with structural similarities to cytosine arabinoside (Ara-C). Activity of gemcitabine is demonstrated in the treatment of many solid tumors, like pancreas, ovarian and nonsmall cell lung cancer (NSCLC). Although gemcitabine is considered as a drug with a good safety profile, cases of gemcitabine-induced severe pulmonary toxicity (GISPT) were reported as for Ara-C. We performed a systematic review of reported cases on the GISPT. Twenty-nine clinical trials especially interesting NSCLC patients (21) and 21 reported cases recording 40 patients were analyzed. The incidence of the GISPT varies from 0 to 5%. The clinical presentation is a subacute clinical syndrome and is frequently nonspecific. The predominant radiographic pattern on chest X-ray are reticulo-nodular interstitial infiltrates. It was postulated that the physio-pathological mechanism of the GISPT was an inflammatory reaction of the alveolar capillary wall cytokine-mediated, which created an abnormal permeability of its membrane. After the differential diagnosis were ruled out, the discontinuation of the drug and the early initiation of steroids and diuretics are the most frequently performed treatments. Under these conditions, the outcome was favorable in a delay of few days generally for a majority of patients but 20% of patients died. Some risk factors, as a previous pulmonary disease or a previous thoracic irradiation, for the occurrence of the GISPT were proposed. GISPT is rare but sometimes fatal. Its a necessity to increase awareness about it to enhanced an early and suitable management of patients developing such a toxicity after gemcitabine administration. [source] Association of angiotensin-I converting enzyme DD genotype with influenza pneumonia in the elderlyGERIATRICS & GERONTOLOGY INTERNATIONAL, Issue 1 2002Miyuki Onishi Background: Although angiotensin-I converting enzyme (ACE) is known to associate with cough reflex and inflammatory conditions, and both may participate in influenza pneumonia in the elderly, no study has been carried out on the association between influenza pneumonia and the insertion/deletion (I/D) polymorphism of the ACE gene (ACE). Methods: The subjects were 934 elderly inpatients (mean ± SD age of 82 ± 8 years) in a long-term care hospital. The association between ACE I/D and the incidence of influenza-pneumonia events was assessed over a winter season. Data were analyzed by multiple logistic regression analysis, with adjustment for age, gender, already known clinical risk factors, and ACE-inhibitor use. Results: During the follow-up period, 330 patients developed influenza (Directigen FLU-A) and 89 developed influenza pneumonia (Center for Disease Control and Prevention (CDC) criteria with chest X-ray required), 16 fatal and 73 non-fatal. Compared to non-influenza subjects (n = 604) and influenza patients without pneumonia (n = 241), ACE DD genotype (vs ID + II) resulted in a significant risk for all pneumonia (relative risk 2.32 [95% CI: 1.30,4.14] and 2.76 [1.39,4.04]), non-fatal pneumonia (1.91 [1.01,3.63] and 2.57 [1.23,5.39]) and fatal pneumonia (6.27 [1.68,23.3] and 5.15 [1.29,20.5]). Conclusion:ACE I/D polymorphism is a strong and independent risk indicator of influenza pneumonia events in elderly inpatients. [source] The role of selective angiographic embolization of the musculo-skeletal system in haemophiliaHAEMOPHILIA, Issue 4 2009E. C. RODRIGUEZ-MERCHAN Summary., The incidence of haemarthrosis as a result of a spontaneous periarticular aneurysm in haemophilia is very low. In these circumstances, angiographic embolization might be considered as a promising therapeutic and coagulation factor saving option in joint bleeds not responding to replacement of coagulation factor to normal levels. Moreover, embolization should be considered as a possible treatment for postoperative pseudoaneurysms complicating total knee arthroplasty in haemophilia. However, the pathological process of aneurysmal bleeding and clotting factor replacement is entirely different. While embolization is the treatment of choice for some periarticular complications that may occur, it is by no means a panacea for all resistant periarticular bleeds in haemophilia or for postoperative bleeding which usually settles with clotting factor replacement. Another use of arterial embolization is for the treatment of haemophilic tumours of the pelvis, because they can act as a focus for infection and cause cutaneous fistulas. When they present perforations and infections of endogenous origin, their course is usually fatal. Suitable treatment has been investigated on numerous occasions, most of the literature agreeing that the only curative treatment is surgical resection. However, surgical resection after performing arterial embolization to reduce the vascularization of the pseudotumour is a good alternative, thereby reducing the size of the pseudotumour and the risk of bleeding complications during surgery. It is important to bear in mind that despite its efficacy, arterial embolization is an invasive procedure with a reported rate of complications up to 25% (16% minor, 7% serious, 2% death). [source] Necrotizing fasciitis of the head and neck: A report of two patients and reviewHEAD & NECK: JOURNAL FOR THE SCIENCES & SPECIALTIES OF THE HEAD AND NECK, Issue 5 2002Deowall Chattar-Cora MD Abstract Background Necrotizing fasciitis is a disfiguring condition that can be fatal. The head and neck region is rarely affected. However, when involved, the functional and cosmetic sequelae can be considerable. Materials and Methods We present two case histories, discuss salient diagnostic points, treatment, and review published data on this topic. Results With a timely diagnosis we were able to diagnose and appropriately treat these patients. Conclusions Necrotizing fasciitis is a disfiguring condition that can be fatal if not diagnosed in a timely fashion. Diagnosis and treatment require a high index of suspicion, immediate operative intervention, broad-spectrum antibiotics, and appropriate supportive care. © 2002 Wiley Periodicals, Inc. [source] Underage alcohol use, delinquency, and criminal activityHEALTH ECONOMICS, Issue 12 2006Michael T. French Abstract Since 1988, the minimum legal drinking age (MLDA) has been 21 years for all 50 US states. The increasing prevalence of teenagers driving under the influence (DUI) of alcohol and the resulting traffic accidents were two main reasons for raising the MLDA to 21 years. Following the passage of this legislation, several published studies have found that the higher MLDA is associated with a significant reduction in both fatal and non-fatal accidents. While the relationship between MLDA and DUI events among young adults has been extensively studied, less information is available on other potential consequences of underage drinking. The present study uses data from the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC), a recent nationally representative survey, to investigate the effects of underage drinking on a variety of delinquency and criminal activity consequences. After controlling for the endogeneity of alcohol use where appropriate, we find strong evidence that various measures of alcohol consumption are related both to delinquency and to criminal activity. However, the findings are not uniform across gender as we find striking differences between males and females. These results have interesting policy and public health implications regarding underage drinking. Copyright © 2006 John Wiley & Sons, Ltd. [source] Uremic hyperhomocysteinemia: A randomized trial of folate treatment for the prevention of cardiovascular eventsHEMODIALYSIS INTERNATIONAL, Issue 2 2007Areuza C. A. VIANNA Abstract Homocysteine is a risk factor for atherosclerosis in the general population, and serum homocysteine levels are almost universally elevated in chronic renal failure patients. When such patients are treated with dialysis, cardiovascular disease accounts for more than 50% of their mortality, which, in some proportion, may be pathophysiologically related to the elevated serum homocysteine levels. From April 2003 to March 2005, we conducted a 2-year, double-blind, randomized, placebo-controlled trial of 186 patients with end-stage kidney disease due to any cause, who were older than 18 years and stable on hemodialysis. Patients were assigned to receive either oral folic acid 10 mg 3 times a week immediately after every dialysis session under nurse supervision or an identical-appearing placebo for the entire study. On admission, plasma total homocysteine (tHcy) levels were above 13.9 ,mol/L in 96.7% of patients (median 25.0 ,mol/L, range 9.3,104.0 ,mol/L). In the placebo group, tHcy levels remained elevated at 6, 12, and 24 months, while oral folate significantly decreased tHcy to a median value of 10.5 (2.8,20.3) ,mol/L, (p<0.01). During the study, 38 patients (folic acid group 17 vs. placebo group 21; p=0.47) died from cardiovascular disease. Kaplan,Meier life table analysis dealing with the incidence of cardiovascular events, both fatal and nonfatal (myocardial infarction, arrhythmias, angina, heart failure, cerebrovascular accident), showed that 2 years of folic acid treatment and the lowering of the homocysteine blood levels had no effect on cardiovascular events (p=0.41; hazard ratio 1.24, 95% CI 0.74,2.10). However, the carotid artery intima-media wall thickness measured in a blinded fashion decreased from 1.94 ± 0.59 mm to 1.67 ± 0.38 mm (p<0.01) after 2 years of folate therapy. In this short-term study of uremic patients, 2 years of folic acid supplementation normalized the tHcy blood levels in 92.3% of patients but did not change the incidence of cardiovascular events compared with the control group. However, ultrasonography of the common carotid arteries performed at entry and 24 months later showed a significant decrease in intima-media thickness with folate supplementation. This suggests that early folate supplementation may benefit patients with chronic renal failure by preventing cardiovascular deterioration. [source] Lost Opportunity: What a Credit Framework Would Have Added to the National Qualification FrameworksHIGHER EDUCATION QUARTERLY, Issue 3 2001David Gosling This paper outlines the recent work of the Southern England Consortium, SEEC, and the principles to which it is committed. It is argued that the failure of the Quality Assurance Agency (QAA) to grasp the nettle of credit in the recently published National Qualification Framework (NQF) is a blow, although not a fatal one, to the achievement of the objectives which SEEC is attempting to achieve on behalf of its member institutions. In particular, the opportunity to improve access, increase flexibility and support lifelong learning through the use of credit in the NQF has been lost. The value of the concept of level in a credit framework is defended and contrasted with the use of ,qualification level' in the NQF. [source] Langerhans cell histiocytosis: fascinating dynamics of the dendritic cell,macrophage lineageIMMUNOLOGICAL REVIEWS, Issue 1 2010R. Maarten Egeler Summary:, In its rare occurrence, Langerhans cell histiocytosis (LCH) is a dangerous but intriguing deviation of mononuclear phagocytes, especially dendritic cells (DCs). Clinically, the disease ranges from self-resolving or well manageable to severe and even fatal. LCH lesions in skin, bone, and other sites contain high numbers of cells with phenotypic features resembling LCs admixed with macrophages, T cells, eosinophils, and multinucleated giant cells. Here we review current progress in the LCH field based on two central questions: (i) are LCH cells intrinsically aberrant, and (ii) how does the lesion drive pathogenesis? We argue that LCH cells may originate from different sources, including epidermal LCs, tissue Langerin+ DCs, or mononuclear phagocyte precursors. Current and prospective in vitro and in vivo models are discussed. Finally, we discuss recent insights into plasticity of T-helper cell subsets in light of the lesion microenvironment. LCH continues to provide urgent clinical questions thereby inspiring innovative DC lineage research. [source] Carbimazole-induced agranulocytosis: does antineutrophil cytoplasmic antibody have a role?INTERNAL MEDICINE JOURNAL, Issue 4 2010G. Yip Abstract Carbimazole is a drug that is widely used for hyperthyroid disorders, such as Graves' disease. Agranulocytosis is a rare idiosyncratic adverse reaction to the drug which is potentially fatal. This report describes a patient with a history of successfully treated pyoderma gangrenosum, who developed agranulocytosis 3 weeks after commencement of carbimazole for Graves' disease. It may give credence to the theory that implicates antineutrophil cytoplasmic antibodies in the pathogenesis of agranulocytosis induced by antithyroid drugs. [source] Refeeding syndrome in cancer patientsINTERNATIONAL JOURNAL OF CLINICAL PRACTICE, Issue 3 2008M. A. Marinella Summary Background:, Refeeding syndrome (RFS) is a common, yet underappreciated, constellation of electrolyte derangements that typically occurs in acutely ill, malnourished hospitalised patients who are administered glucose solutions or other forms of intravenous or enteral nutrition. Discussion:, The hallmark of RFS is hypophosphataemia, but hypokalaemia and hypomagnesaemia are also common. Patients with various types of malignancies are at-risk for RFS, but very little exists in the oncologic literature about this disorder. Conclusions:, As RFS can have many adverse metabolic, cardiovascular, haematologic and neurologic complications, practicing oncologist needs to be aware of the pathophysiology, risk factors and clinical manifestations to promptly recognise this important, and potentially fatal, metabolic disorder. [source] The collaborative atorvastatin diabetes study: preliminary results,INTERNATIONAL JOURNAL OF CLINICAL PRACTICE, Issue 1 2005Olwen Glynn Owen Summary The Collaborative AtoRvastatin Diabetes Study (CARDS) is the first large primary prevention study to focus specifically on the role of a statin in patients aged 40,75 years with type 2 diabetes, but no signs or symptoms of pre-existing vascular disease and who had only average or below average cholesterol levels. The trial was a prospective double-blind randomised trial with 2383 type 2 diabetic subjects randomised to either 10-mg atorvastatin daily or placebo. Originally designed to run for 5 years, the trial was terminated over a year early in June 2003 on account of a clear benefit demonstrated for the intervention group. Over half of patients had a low-density lipoprotein cholesterol (LDL-C) below 3.3 mmol/l at entry and a quarter had an LDL-C <2.6 mmol/l. Atorvastatin 10 mg reduced LDL-C by 40% (1.2 mmol/l) on average. Results at 4 years showed a 37% relative risk reduction (p < 0.001) for atorvastatin 10 mg in the primary endpoint (acute coronary heart disease death, fatal or non-fatal myocardial infarction, unstable angina requiring hospital admission, resuscitated cardiac arrest, coronary revascularisation procedures and stroke). Among the secondary endpoints, total mortality was reduced by 27% (p = 0.05), acute coronary events by 36%, coronary revascularisation by 31% and stroke by 48%. The same magnitude of benefit was observed among patients with LDL-C above or below 3 mmol/l. Results observed were against a background where 9% of placebo patients had been permitted to start statin therapy after enrolment and 15% of patients on active treatment had discontinued atorvastatin. The true benefit of the intervention is therefore probably around 25% greater than the intention to treat analysis reports. [source] Pyoderma gangrenosum: a report of 21 casesINTERNATIONAL JOURNAL OF DERMATOLOGY, Issue 2 2002Rym Benmously Mlika MD Background Pyoderma gangrenosum (PG) is an uncommon, destructive, cutaneous ulceration, belonging to the neutrophilic disease spectrum. It is associated with systemic disease in 50% of cases. Methods We report a retrospective study of 21 cases of PG. All cases studied fulfilled the following criteria: (i) clinical features of PG; (ii) histopathology consistent with a diagnosis of PG, and excluding other specific dermatoses. Results The average age of our patients was 41.8 years. The male to female ratio was 1.1. The typical ulcerative variant was found in 17 patients, bullous PG in two patients, and the granulomatous variant in two patients. Sixty-two per cent of our patients had lesions on their lower legs. Two patients had neutrophilic pulmonary involvement concurrent with the ulcers. An association with other internal diseases was noted in 12 patients. Histopathologic study showed vasculitis in 13 patients. Of these, 11 were leukocytoclastic and the others predominantly lymphocytic. Conclusions PG is a rare disease, with the ulcerative variant being most frequent. The lower legs are the most commonly affected sites. The recurrence rate in our study was about 46% regardless of the treatment prescribed. Pulmonary involvement was fatal in two patients. [source] Intramedullary fat necrosis, polyarthritis and panniculitis with pancreatic tumor: a case reportINTERNATIONAL JOURNAL OF RHEUMATIC DISEASES, Issue 4 2010Vivek VASDEV Abstract Acute polyarthritis can occur in non-rheumatic systemic illnesses, presenting a diagnostic dilemma. We present an extremely rare case presenting as acute polyarthritis, panniculitis and medullary fat necrosis with underlying pancreatic pathology. This case report describes a young woman presenting with panniculits, pancreatic tumour, polyarthritis and intra-osseus fat necrosis with a fatal outcome. The medical fraternity needs to be aware of this potentially fatal albeit rare musculoskeletal complication secondary to a pancreatic pathology. [source] | |||||||||||||||||||