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Sudden Onset (sudden + onset)
Selected Abstracts48 YEAR OLD MALE WITH SUDDEN ONSET OF RIGHT SIDED WEAKNESSBRAIN PATHOLOGY, Issue 2 2006Alexander Easton MBBS PhD No abstract is available for this article. [source] ROLE OF ENDOSCOPY IN SCREENING OF EARLY PANCREATIC CANCER AND BILE DUCT CANCERDIGESTIVE ENDOSCOPY, Issue 2009Kiyohito Tanaka In the screening of early pancreatic cancer and bile duct cancer, the first issue was ,what are the types of abnormality in laboratory data and symptoms in case of early pancreatic cancer and bile duct cancer?' Early cancer in the pancreaticobiliary region has almost no symptoms, however epigastralgia without abnormality in the gastrointestinal (GI) tract is a sign of early stage pancreaticobiliary cancer. Sudden onset and aggravation of diabetes mellitus is an important change in the case of pancreatic cancer. Extracorporeal ultrasonography is a very useful procedure of checking up changes of pancreatic and biliary lesions. As the role of endoscopy in screening, endoscopic ultrasonography (EUS) is the most effective means of cancer detection of the pancreas, and endoscopic retrograde cholangiopancreatography (ERCP) is most useful of diagnosis tool for abnormalities of the common bile duct. Endoscopic retrograde cholangiopancreatography is an important modality as the procedure of sampling of diagnostic materials. Endoscopic ultrasonography-fine needle aspiration (EUS-FNA) has the role of histological diagnosis of pancreatic mass lesion also. Especially, in the case of pancreas cancer without evidence of cancer by pancreatic juice cytology and brushing cytology, EUS-FNA is essential. Intra ductal ultrasonography (IUDS) and perotral cholangioscopy (POCS) are useful for determination of mucosal extent in extrahepatic bile duct cancer. Further improvements of endoscopical technology, endoscopic procedures are expected to be more useful modalities in detection and diagnosis of early pancreatic and bile duct cancers. [source] Two clinical manifestations of desmopathy of the accessory ligament of the deep digital flexor tendon in the hindlimb of 23 horsesEQUINE VETERINARY JOURNAL, Issue 6 2005E. ELIASHAR Summary Reasons for performing study: Desmopathy of the accessory ligament of the deep digital flexor tendon (ALDDFT) in the hindlimb is an unusual cause of lameness in horses, and reports of the condition are sparse. Objectives: To describe the clinical and ultrasonographic findings, therapy and outcome of 23 horses treated for desmopathy of the ALDDFT in the hindlimb. Methods: Records of 23 horses with ultrasonographic evidence of desmopathy of the ALDDFT in one or both hindlimbs from 3 referral centres were reviewed retrospectively. Age, breed, sex, duration and nature of clinical signs, results of clinical and lameness examinations, treatment and outcome were recorded. Results: In 13 horses (Group A), there was an acute onset of unilateral lameness. Ten horses (Group B) had an insidious or sudden onset of postural abnormality. There were 10 cobs, 5 British native-breed ponies and 8 horses of various larger breeds. Twenty horses were used for general purposes, and mean age was 12 years. Enlargement of the ALDDFT in the affected hindlimb(s) was identified in all horses. In 44% of horses, ultrasonographic abnormalities were localised to part of the ALDDFT. Treatment included box-rest and controlled exercise, and 10 horses were subjected to desmotomy or desmectomy of the ALDDFT. Seventy-three percent of horses in Group A returned to full function, while 90% of those in Group B remained lame. Conclusions: Two distinct clinical conditions are associated with the ALDDFT of the hindlimb. Traumatically induced injury resulting in acute onset lameness appears to have a favourable prognosis, with most horses returning to previous work. However, postural changes, once present, are irreversible and indicate a poor prognosis. Potential relevance: Desmopathy of the ALDDFT should be recognised as a potential cause of hindlimb lameness and this study provides clinical and prognostic information. Knuckling and/or semiflexion of the metatarsophalangeal joint may accompany the condition; therefore, if a horse is presented with a flexural deformity of this joint, desmopathy of the ALDDFT should be considered as a primary differential diagnosis. [source] Microscale vegetation-soil feedback boosts hysteresis in a regional vegetation,climate systemGLOBAL CHANGE BIOLOGY, Issue 5 2008RUUD H. H. JANSSEN Abstract It has been hypothesized that a positive feedback between vegetation cover and monsoon circulation may lead to the existence of two alternative stable states in the Sahara region: a vegetated state with moderate precipitation and a desert state with low precipitation. This could explain the sudden onset of desertification in the region about 5000 years ago. However, other models suggest that the effect of vegetation on the precipitation may be insufficient to produce this behavior. Here, we show that inclusion of the microscale feedback between soil and vegetation in the model greatly amplifies the nonlinearity, causing alternative stable states and considerable hysteresis even if the effect of vegetation on precipitation is moderate. On the other hand, our analysis suggests that self-organized vegetation patterns known from models that only focus at the microscale plant,soil feedback will be limited to a narrower range of conditions due to the regional scale climate-feedback. This implies that in monsoon areas such as the Western Sahara self-organized vegetation patterns are predicted to be less common than in areas without monsoon circulation such as Central Australia. [source] Acquired factor VIII inhibitor presenting as macular haemorrhageHAEMOPHILIA, Issue 2 2005C. Hon Summary., We report a rare case of idiopathic acquired factor VIII inhibitor in an 80-year old Chinese man presented as sudden onset of monocular blindness because of macular haemorrhage. This was complicated by painful glaucoma that did not respond to medical treatment. The patient died of cerebral haemorrhage shortly afterwards. Most cases of reported intraocular bleeding in acquired haemophiliacs are iatrogenic because of intraocular operations in undiagnosed cases, and spontaneous intraocular haemorrhage has never been reported. The literature reports of intraocular bleeding in hereditary and acquired haemophilia cases are summarized. [source] Changes in the Ability to Detect Ordinal Numerical Relationships Between 9 and 11 Months of AgeINFANCY, Issue 4 2008Sumarga H. Suanda When are the precursors of ordinal numerical knowledge first evident in infancy? Brannon (2002) argued that by 11 months of age, infants possess the ability to appreciate the greater than and less than relations between numerical values but that this ability experiences a sudden onset between 9 and 11 months of age. Here we present 5 experiments that explore the changes that take place between 9 and 11 months of age in infants' ability to detect reversals in the ordinal direction of a sequence of arrays. In Experiment 1, we replicate the finding that 11- but not 9-month-old infants detect a numerical ordinal reversal. In Experiment 2 we rule out an alternative hypothesis that 11-month-old infants attended to changes in the absolute numerosity of the first stimulus in the sequence rather than a reversal in ordinal direction. In Experiment 3, we demonstrate that 9-month-old infants are not aided by additional exposure to each numerosity stimulus in a sequence. In Experiment 4 we find that 11-month-old but not 9-month-old infants succeed at detecting the reversal in a nonnumerical size or area-based rule, casting doubt on Brannon's prior claim that what develops between 9 and 11 months of age is a specifically numerical ability. In Experiment 5 we demonstrate that 9-month-old infants are capable of detecting a reversal in ordinal direction but only when there are multiple converging cues to ordinality. Collectively these data indicate that at 11 months of age infants can represent ordinal relations that are based on number, size, or cumulative area, whereas at 9 months of age infants are unable to use any of these dimensions in isolation but instead require a confluence of cues. [source] Supraventricular Arrhythmias in Children and Young Adults with Implantable Cardioverter DefibrillatorsJOURNAL OF CARDIOVASCULAR ELECTROPHYSIOLOGY, Issue 10 2001BARRY A. LOVE M.D. SVT in Pediatric ICD Recipients.Introduction: Rapidly conducted supraventricular tachycardias (SVTs) can lead to inappropriate device therapy in implantable cardioverter defibrillator (ICD) patients. We sought to determine the incidence of SVTs and the occurrence of inappropriate ICD therapy due to SVT in a pediatric and young adult population. Methods and Results: We undertook a retrospective review of clinical course, Holter monitoring, and ICD interrogations of patients receiving ICD follow-up at our institution between March 1992 and December 1999. Of 81 new ICD implantations, 54 eligible patients (median age 16.5 years, range 1 to 48) were identified. Implantation indications included syncope and/or spontaneous/inducible ventricular arrhythmia with congenital heart disease (30), long QT syndrome (9), structurally normal heart (ventricular tachycardia/ventricular fibrillation [VT/VF]) (7), and cardiomyopathies (7). Sixteen patients (30%) received a dual-chamber ICD. SVT was recognized in 16 patients, with 12 of 16 having inducible or spontaneous atrial tachycardias. Eighteen patients (33%) received , 1 appropriate shock(s) for VT/VF; 8 patients (15%) received inappropriate therapy for SVT. Therapies were altered after an inappropriate shock by increasing the detection time or rate and/or increasing beta-blocker dosage. No single-chamber ICD was initially programmed with detection enhancements, such as sudden onset, rate stability, or QRS discriminators. Only one dual-chamber defibrillator was programmed with an atrial discrimination algorithm. Appropriate ICD therapy was not withheld due to detection parameters or SVT discrimination programming. Conclusion: SVT in children and young adults with ICDs is common. Inappropriate shocks due to SVT can be curtailed even without dual-chamber devices or specific SVT discrimination algorithms. [source] Necrotizing vasculitis with a polyarteritis nodosa-like pattern and selective immunoglobulin A deficiency: case report and review of the literatureJOURNAL OF CUTANEOUS PATHOLOGY, Issue 9 2008Sabela Paradela Selective immunoglobulin A deficiency (IgAD) is a primary immunodeficiency disease characterized by low levels (< 7 mg/dl) of serum immunoglobulin (Ig) A and normal serum levels of IgG and IgM. Patients with IgAD have increased risk for recurrent respiratory and gastrointestinal infections, autoimmune disease, asthma and allergy. A 26-year-old woman was admitted with sudden onset of painful cutaneous lesions on her lower extremities, pyrexia and arthromyalgia. Her medical history was remarkable for recurrent respiratory tract infections, self-limited episodes of acute diarrhea, atopy, splenomegaly and a 4-year history of a lung granulomatous lesion. Laboratory and imaging tests ruled out severe life-threatening infection, connective tissue disease and neoplasm. Serum protein electrophoresis showed a low IgA serum level (6.67 mg/dl), with normal serum levels of IgG and IgM, conducting to a diagnosis of selective IgAD. A skin biopsy showed necrotizing vasculitis without any sign of internal organ disease. We report a patient with IgAD and granulomatous involvement of lungs, spleen and medium-sized arteries of the skin. Although IgAD results from a failure of B-cell differentiation, we propose that deregulated immune response with production of cross-reactive antibodies and hyperstimulation of T cells and macrophages could contribute to this widespread granulomatous reaction. [source] Ipsilateral Hemiplegia in a Lateral Medullary Infarct, Opalski's SyndromeJOURNAL OF NEUROIMAGING, Issue 1 2003Yasuyuki Kimura MD ABSTRACT A 42-year-old man was admitted complaining of the sudden onset of headache, vomiting, vertigo, and gait disturbance. The authors found hemiparesis of his right limbs, right Horner's syndrome, and decreased pain and temperature sensation of his right face and left limbs. Diffusion-weighted imaging (DWI) showed an acute small infarct located on the right side of the lateral lower medulla. This is the first report of Opalski's syndrome with lower medullary infarction detected by DWI. [source] Identification of focal adenomyosis as a uterine lesion in two dogsJOURNAL OF SMALL ANIMAL PRACTICE, Issue 8 2001N. M. Stöckun-Gautschi A focal uterine adenomyosis is described in two bitches. In both cases, the uterus showed knobbly enlargements of 4 to 8 cm in diameter, which resulted in distinct clinical symptoms. Other pathological changes of the uterus were not present. One bitch was presented because of a history of vaginal discharge of several months' duration. Radiographs, as well as ultrasonography, revealed a soft tissue lesion at the cervix. The other bitch showed a marked reduction In its general condition and a sudden onset of a tense abdomen. Radiologically, a lesion of soft tissue opacity was observed in the mid-abdomen and was seen to originate from the left uterine horn during exploratory laparotomy. A torsion of the lesion was present, which explained the clinical signs in this second case. [source] Review article: diagnosis and management of mesenteric ischaemia with an emphasis on pharmacotherapyALIMENTARY PHARMACOLOGY & THERAPEUTICS, Issue 3 2005P. L. Kozuch Summary Mesenteric ischaemia results from decreased blood flow to the bowel, causing cellular injury from lack of oxygen and nutrients. Acute mesenteric ischaemia (AMI) is an uncommon disorder with high morbidity and mortality, but outcomes are improved with prompt recognition and aggressive treatment. Five subgroups of AMI have been identified, with superior mesenteric artery embolism (SMAE) the most common. Older age and cardiovascular disease are common risk factors for AMI, excepting acute mesenteric venous thrombosis (AMVT), which affects younger patients with hypercoaguable states. AMI is characterized by sudden onset of abdominal pain; a benign abdominal exam may be observed prior to bowel infarction. Conventional angiography and more recently, computed tomography angiography, are the cornerstones of diagnosis. Correction of predisposing conditions, volume resuscitation and antibiotic treatment are standard treatments for AMI, and surgery is mandated in the setting of peritoneal signs. Intra-arterial vasodilators are used routinely in the treatment of non-occlusive mesenteric ischaemia (NOMI) and also are advocated in the treatment of occlusive AMI to decrease associated vasospasm. Thrombolytics have been used on a limited basis to treat occlusive AMI. A variety of agents have been studied in animal models to treat reperfusion injury, which sometimes can be more harmful than ischaemic injury. Chronic mesenteric ischaemia (CMI) usually is caused by severe obstructive atherosclerotic disease of two or more splanchnic vessels, presents with post-prandial pain and weight loss, and is treated by either surgical revascularization or percutaneous angioplasty and stenting. [source] Dopamine receptor gene polymorphisms in Parkinson's disease patients reporting "sleep attacks"MOVEMENT DISORDERS, Issue 11 2004Ida Rissling MD Abstract Genes encoding proteins involved in dopaminergic transmission are potential candidate genes for the induction of somnolence in Parkinson's disease (PD) because dopaminergic agents have been shown to be associated with sudden onset of sleep (SOS) in PD. We conducted an association study on dopamine D2, D3, and D4 receptor gene polymorphisms comparing 137 PD patients with SOS and 137 PD patients without SOS matched according to drug therapy, disease duration, sex, and age. Our results show a significant association between the dopamine D2 receptor gene polymorphism Taq IA and SOS in PD. No significant association between two other investigated polymorphisms and the phenomenon of "sleep attacks" in PD was observed. © 2004 Movement Disorder Society [source] Epicardial Ablation of Ventricular Tachycardia Associated with Isolated Ventricular NoncompactionPACING AND CLINICAL ELECTROPHYSIOLOGY, Issue 7 2006HONG EUY LIM A 52-year-old man presented with sudden onset of palpitations and dizziness. Echocardiogram confirmed the diagnosis of isolated noncompaction of ventricular myocardium with moderated systolic dysfunction, and the electrocardiogram (ECG) revealed ventricular tachycardia (VT), of which the focus seemed to match an area of prominent left ventricular noncompaction on the 12-lead surface ECG. Through the activation mapping from the endo- and epicardium, simultaneously, a discrete potential preceding the QRS during VT was observed at the anterolateral epicardial wall. He subsequently underwent radiofrequency ablation, and VT was successfully eliminated. [source] Runaway Pulse Generator Malfunction Resulting from Undetected Battery DepletionPACING AND CLINICAL ELECTROPHYSIOLOGY, Issue 2 2002PUGAZHENDHI VIJAYARAMAN VIJAYARAMAN, P., et al.: Runaway Pulse Generator Malfunction Resulting from Undetected Battery Depletion. Runaway pacemaker is an uncommon, potentially lethal circuit malfunction characterized by sudden onset of erratic pacing at rapid nonphysiological rates. Two patients with a single chamber pacemaker (Medtronic ST 8331 and 8419) presented with episodic dizziness. ECG revealed recurrent decrescendo amplitude episodes of runaway stimuli at 2,400 and 2,600 ppm, approximately 3 seconds in duration, separated by pacing at 62.5 and 65 ppm, respectively. Fortunately the runaway stimuli were subthreshold and did not result in capture of the ventricle. Emergency pulse generator replacement was uneventful. Both leads were normal and both pulse generators had low battery voltages at 1.488 and 1.78 V, respectively. [source] Graft failure secondary to necrotizing enterocolitis in multi-visceral transplantation recipients: Two case reportsPEDIATRIC TRANSPLANTATION, Issue 3 2000Farrukh A. Khan Abstract: We report on two recipients of multi-visceral grafts who exhibited sudden onset of acute abdomen discomfort 2 weeks post-transplantation after a fairly uneventful immediate post-operative course. Both patients were shown to have pneumatosis intestinalis and one had air in the portal vein. Both patients underwent exploration, which showed non-viable intestine (terminal ileum and colon in the first patient and the entire small intestine distal to the ligament of Treitz in the second patient). There was no vascular thrombosis. The necrotic intestine was resected in both cases. The first patient developed sepsis and died 15 days later despite the rescue efforts. The second patient was re-transplanted twice and is doing well. The histopathology of the segments involved revealed cryptitis, vasculitis, and features of transmural necrosis. Accordingly, both clinical and pathologic features are diagnostic of necrotizing enterocolitis. To our knowledge this is the first report of this complication following intestinal or multi-visceral transplantation. [source] Solar urticaria treated successfully with intravenous high-dose immunoglobulin: a case reportPHOTODERMATOLOGY, PHOTOIMMUNOLOGY & PHOTOMEDICINE, Issue 6 2008Isabel Correia Solar urticaria is an idiopathic, chronic and rare photodermatosis, characterized by the sudden onset of pruritic urticarial hives and plaques on the exposed areas of the skin, after a brief period of exposure to the natural sunlight or to an artificial light source. A Caucasian 27-year-old man presented with clinical features suggestive of solar urticaria was referred to our photodermatology unit, where phototesting confirmed the diagnosis of solar urticaria induced by visible light. As he was refractory to oral antihistamines and had slight improvement under UVA plus visible phototherapy, human high-dose intravenous immunoglobulin was administered, with an excellent clinical-sustained response. [source] Risk factors and independent predictors of survival in patients with pulmonary epithelioid haemangioendothelioma.RESPIROLOGY, Issue 6 2006Review of the literature, a case report Abstract: Pulmonary epithelioid haemangioendothelioma (PEH) is a rare pulmonary neoplasm. A patient with PEH with lymph node and pleural metastases that were discovered incidentally is described. An abnormal left upper lobe shadow was noticed on CXR in a 70-year-old woman during an assessment for the sudden onset of nausea and vomiting. Transbronchial lung biopsy did not provide a diagnosis. Lobectomy and lymph node resection were performed. The histological diagnosis of PEH was confirmed immunohistochemically by positive reactions to factor VIII-related antigen and CD34. Data on 93 patients with PEH including the present case report were analysed by Cox regression analysis using forward stepwise method to identify the risk factors, and the independent predictors of survival in patients with PEH. It revealed that male, symptomatic patients, presence of cough, haemoptysis, chest pain, multiple unilateral nodules, pleural effusion, metastases to more than one site and lymph node metastases were all significant risk factors for PEH (P < 0.05). Symptomatic patients and presence of pleural effusion were the independent predictors of survival in patients with PEH. [source] The response of the coupled tropical ocean,atmosphere to westerly wind burstsTHE QUARTERLY JOURNAL OF THE ROYAL METEOROLOGICAL SOCIETY, Issue 579 2002Alexey V. Fedorov Abstract Two different perspectives on El Niño are dominant in the literature: it is viewed either as one phase of a continual southern oscillation (SO), or alternatively as the transient response to the sudden onset of westerly wind bursts (WWBs). Occasionally those bursts do indeed have a substantial effect on the SO,the unusual strength of El Niño of 1997/98 appears to be related to a sequence of bursts,but frequently the bursts have little or no impact. What processes cause some bursts to be important, while others remain insignificant? The question is addressed by using a simple coupled tropical ocean,atmosphere model that simulates a continual, possibly attenuating, oscillation to study the response to WWBs. The results show that the impact of WWBs depends crucially on two factors: (i) the background state of the system as described by the mean depth of the thermocline and intensity of the mean winds, and (ii) the timing of the bursts with respect to the phase of the SO. Changes in the background conditions alter the sensitivity of the system, so that the impact of the bursts on El Niño may be larger during some decades than others. Changes in the timing of WWBs affect the magnitude and other characteristics of the SO by modifying the energetics of the ocean,atmosphere interactions. A reasonable analogy is a swinging pendulum subject to modest blows at random times,those blows can either magnify or diminish the amplitude, depending on their timing. It is demonstrated that a WWB can increase the strength of El Niño significantly, if it occurs 6 to 10 months before the peak of warming, or can reduce the intensity of the subsequent El Niño, if it occurs during the cold phase of the continual SO. Copyright © 2002 Royal Meteorological Society. [source] Ganser syndrome: a case report from ThailandASIA-PACIFIC PSYCHIATRY, Issue 1 2009Kanida Tassniyom MD Abstract Ganser syndrome or "syndrome of approximates" is characterized by the patient giving incorrect answers to questions, despite showing an understanding of the questions, clouding of consciousness, perceptual abnormalities and symptoms of somatic conversion. The syndrome has a sudden onset, resolves abruptly, and is followed by subsequent amnesia. It was first described by Sigbert Ganser in 1897. It was earlier described as a hysterical disorder, and debate about its classification continues today. Currently, it is categorized under the rubric of dissociative disorder. Overall, fewer than 50 cases have been reported. The etiology of Ganser syndrome remains unknown. Some precipitating stressors have been reported and in other cases patients have had organic brain syndrome. Hospital admission has been recommended, but treatment with antipsychotic medication is not necessarily advised because the syndrome can resolve without treatment. The prognosis is uncertain. The present report is of a 40-year-old Thai male with symptoms of clouding of consciousness, approximate answers to simple questions, reported auditory hallucinations and somatic delusions. All symptoms resolved within 5 days and the patient had no recollection of the event. Ganser syndrome is still considered a rare psychiatric syndrome requiring further exploration. [source] Acute unilateral poliosis concurrent with trigeminal autonomic cephalalgia: A possible aetiological associationAUSTRALASIAN JOURNAL OF DERMATOLOGY, Issue 1 2010Do-Young Kwon ABSTRACT We report a 24-year-old man who presented with the sudden onset of unilateral poliosis associated with acute trigeminal autonomic cephalalgia, suggesting a pathophysiology in common and a possible neural hypothesis in the development of segmental vitiligo. Although rare, associations with neurological abnormalities should be considered in cases of focal depigmentation disorders. [source] Syncope associated with hypertrophic cardiomyopathy in a dromedary camelAUSTRALIAN VETERINARY JOURNAL, Issue 8 2000C GUTIERREZ A case of hypertrophic cardiomyopathy in a dromedary camel (Camelus dromedarius) is described for the first time. The patient, a castrated 9-year-old animal, presented with a 6-month history of several episodes of syncope after moderate exercise and later at rest. The syncope had a sudden onset and a duration of 30 to 45 seconds. After clinical, electro-cardiographical and echocardiographical examination, a tentative diagnosis of hypertrophic cardiomyopathy was made. At necropsy, the heart had a globose shape and was firm on palpation. The left ventricular free wall and the inter-ventricular septum were thickened in cross-section and the left ventricular lumen was small. The clinical diagnosis was confirmed by histologic examination of heart tissue that demonstrated hypertrophy of myocardial fibres with vesicular nuclei and the presence of diffuse interstitial fibrosis. [source] Assessment of Acute Respiratory and Cardiovascular Toxicity of Casiopeinas in Anaesthetized DogsBASIC AND CLINICAL PHARMACOLOGY & TOXICOLOGY, Issue 3 2007Marco Leal-García Considering therapeutic dose ranges from 3.6 to 18 mg/m2 for the former and 1.2 to 3 mg/m2 for the latter, true therapeutic margin of safety varies from 4.7 to 23.6 mg/m2 and from 20 to 50 mg/m2, respectively. For both casiopeinas intravenous administration of the corresponding lethal dose in 100 ml of 5% dextrose solution in a time period of 30 min. induced death after an almost uneventful latency time period of 30,50 min. Then, after an apparently sudden onset, changes in blood gases indicated respiratory distress (PO2 from 82.5% to 26.5% for casiopeina III-ia and from 88.6% to 37.5% for casiopeina IIgly; end-tidal CO2 from 38 to 8.1 mmHg for the first and from 35.1 to 11.2 mmHg for the second, this was almost simultaneously confirmed by the onset of tachypnoea (from 16 to almost 60 breaths/min. for both casiopeinas) and by a drop in arterial blood pressure (from 117 to 51 mmHg for casiopeina III-ia and from 108 to 49 mmHg for casiopeina IIgly). Reflex tachycardia occurs at the beginning of intravenous administration followed by bradycardia a few minutes later (from 158 to 63 beats/min. for casiopeina III-ia and from 148 to 56 beats/min. for casiopeina IIgly). Finally, cardiac arrest occurred no later than 25 min. towards the end of these events lung oedema appeared as fluid dripping from the endotracheal tube. Death occurred in a mean of 15 ± 5 min. S.D. from the beginning of the end of the latency period. For both casiopeina's data allow the speculation that lung oedema is caused by a joined toxicity to the lung capillary bed, and particularly to the heart. Carvedilol premedication for 8 days delayed the outcome of lung oedema by approximately 8 hr but could not prevent it. [source] Poster 2, Acne fulminans: part of the spectrum of SAPHOBRITISH JOURNAL OF DERMATOLOGY, Issue 6 2007S.L. Chua A 13-year-old boy was admitted to hospital with severe back pain and systemic upset. He had commenced isotretinoin 25 mg (0·5 mg kg,1) daily 17 days previously for severe acne unresponsive to oral erythromycin. Isotretinoin was stopped after 4 days due to severe lower back pain. On admission, he was unable to mobilize and the pain was uncontrolled with oral morphine sulphate. Investigations showed leucocytosis and neutrophilia. Magnetic resonance imaging of the vertebrae showed multiple areas of high signal consistent with an inflammatory process such as osteomyelitis. Oral prednisolone 40 mg daily and ibuprofen controlled the pain within 2 days. Sulfasalazine (1 g twice daily) was commenced 10 days later. The re-introduction of isotretinoin 5 mg daily 12 days after admission precipitated severe back pain, necessitating 3 days of intravenous methylprednisolone. The oral prednisolone dose has been reduced over 6 weeks and stopped. The acne is currently controlled with clindamycin, although there is marked scarring. Acne fulminans is a rare condition characterized by sudden onset of severe acne and systemic features such as fever, leucocytosis and arthralgia.1 Osteomyelitic lesions are a recognized feature. In 1987, the term SAPHO (synovitis, acne, pustulosis, hyperostosis, osteitis) syndrome was proposed to describe a clinical entity with skin, joint and bone manifestations. Associated skin conditions include severe acne, psoriasis and palmoplantar pustulosis. Reported sites of osteoarticular involvement include the anterior chest wall, vertebrae, pelvis and mandible.2 Our patient clearly has acne fulminans and fulfils the criteria for SAPHO syndrome. We believe this condition will be increasingly recognized by dermatologists. References 1 Karvonen S. Acne fulminans: report of clinical findings and treatment of twenty-four patients. J Am Acad Dermatol 1993; 28:572,9. 2 Hayem G, Bouchaud-Chabot A, Benali K et al. SAPHO syndrome: a long-term follow-up study of 120 cases. Semin Arthritis Rheum 1999; 29:159,71. [source] Spontaneous tumour rupture and prognosis in patients with hepatocellular carcinomaBRITISH JOURNAL OF SURGERY (NOW INCLUDES EUROPEAN JOURNAL OF SURGERY), Issue 9 2002C.-N. Yeh Background: Hepatocellular carcinoma (HCC) is a common disease in Taiwan. Ruptured HCC is an uncommon and potentially fatal complication of the condition. Information on the impact of ruptured HCC on hepatic resection is, however, limited. Methods: The clinical features of 60 patients with ruptured HCC who underwent hepatic resection from 1986 to 1998 were reviewed. Clinical features and factors influencing the outcome of 475 patients with non-ruptured HCC were used for comparison. Results: Of 535 surgically resected HCCs, 60 (11·2 per cent) were ruptured. Univariate analysis showed that sudden onset of abdominal pain, physical signs of haemodynamic unstability, reduced haemoglobin level and a raised aspartate aminotransferase level were more frequently found in patients with ruptured HCC than in those with non-ruptured tumours. Multivariate stepwise logistic regression analysis revealed sudden-onset abdominal pain to be the only independently significant factor in patients in the ruptured HCC group. The 1-, 3- and 5-year survival rates of patients with non-ruptured HCC were 72·1, 47·3 and 33·9 per cent, and those of patients with ruptured HCC were 54·2, 35·0 and 21·2 per cent respectively. Similar overall survival rates were found in patients with ruptured and non-ruptured HCC, although patients in the non-ruptured HCC group had a significantly better disease-free survival rate (P = 0·023). Conclusion: The presence of sudden-onset abdominal pain is the only independent indicator of ruptured HCC. Hepatic resection, when feasible, is the treatment of choice and can result in an overall survival rate comparable to that of patients with non-ruptured HCC. © 2002 British Journal of Surgery Society Ltd [source] Accidental mydriasis from exposure to Angel's trumpet (Datura suaveolens)ACTA OPHTHALMOLOGICA, Issue 3 2002Ulf Havelius ABSTRACT. Purpose:, To report clinical findings after accidental instillation into the eye of sap from Angel's trumpet (Datura suaveolens). Methods:, We report findings on seven patients who developed sudden onset of unilateral mydriasis. At least three of them also had ipsilateral cycloplegia and one developed transient tachycardia. Results:, The symptoms evolved after ocular exposure to sap from Angel's trumpet, a plant containing natural alkaloids with parasympatholytic properties. Six patients were initially unaware of the cause of their symptoms. In these cases, patient history revealed recent contact with Angel's trumpet. Conclusion:, Accidental ocular instillation of sap from Angel's trumpet should be noted as a cause of sudden onset of mydriasis in otherwise unaffected patients and also of general symptoms like tachycardia. [source] Acne fulminans ,sine fulminans'CLINICAL & EXPERIMENTAL DERMATOLOGY, Issue 4 2000K. F. Thomson Acne fulminans is characterized by the sudden onset of a severe, ulcerative acne associated with systemic features. Response to traditional acne therapies is poor. We have recognized a subset of patients with acne of a severity comparable to that of acne fulminans but with the absence of systemic involvement; we suggest modification of the treatment regimes used in this group. [source] Systolic Total Narrowing of Left Anterior Descending Coronary Artery and Flow Interruption Secondary to Myocardial Bridge: A Rare Case Report and Review of LiteratureCLINICAL CARDIOLOGY, Issue 10 2008Fehmi Kacmaz MD Abstract A 33-y-old man was admitted to the emergency department with sudden onset of severe substernal chest pain radiating to the left arm and neck. No pathological signs were recorded upon physical examination. The admission electrocardiogram (ECG) recorded during chest pain showed a large anterior wall myocardial infarction. Intravenous (IV) infusion of 1.5 million units of streptokinase over 1 h was initiated. Coronary angiography revealed total narrowing and flow interruption in the midsegment of the left anterior descending (LAD) coronary artery secondary to a myocardial bridge during systole and disappearance with diastole. He was discharged on aspirin (300 mg/d), metoprolol (100 mg/d), enalapril (10 mg twice daily), and atorvastatin (40 mg/d) treatment at the follow-up period. Copyright © 2008 Wiley Periodicals, Inc. [source] Clinical and endoscopic characteristics of acute haemorrhagic rectal ulcer, and endoscopic haemostatic treatment: a retrospective study of 95 patientsCOLORECTAL DISEASE, Issue 10Online 2010Y. Motomura Abstract Aim, Acute haemorrhagic rectal ulcer (AHRU) is characterized by sudden onset of painless and massive rectal bleeding in elderly bedridden patients who have serious illness. Endoscopic diagnosis and management of AHRU is, however, still controversial. We retrospectively investigated 95 AHRU patients to elucidate the clinical characteristics, endoscopic findings and haemostatic strategies. Method, Between January 1999 and March 2007, 95 patients were diagnosed with AHRU in our hospital. Medical records and colonoscopy files were reviewed. Clinical features, colonoscopic findings, haemostatic treatment and outcome of the patients were evaluated. Results, Eighty per cent of the patients were bedridden at the onset. The most frequent underlying disorder was cerebrovascular disease (36.8%). Hypoalbuminaemia (< 3.5 g/dl) was seen in 92.6% of the patients. Endoscopic findings of AHRU were classified as circumferential ulcer (41.1%), linear or nearly round small ulcer(s) (44.2%), circumferential and small ulcer(s) (7.4%) and Dieulafoy-like ulcer (7.4%). Primary endoscopic haemostatic treatment was performed in 45.3% of cases. Recurrent bleeding occurred in 24.2% of patients. Permanent haemostasis was achieved by secondary endoscopic treatment in 82.6% of re-bleeding patients. Conclusion, Understanding the typical clinical and endoscopic findings and careful endoscopic examination are important for the accurate diagnosis of AHRU, and endoscopic haemostatic therapy may be effective for bleeding patients. [source] Physiologic reactivity to startling tones in female vietnam nurse veterans with PTSDJOURNAL OF TRAUMATIC STRESS, Issue 5 2007Margaret A. Carson Posttraumatic stress disorder (PTSD) is associated with larger heart rate (HR), skin conductance (SC), and eyeblink responses to sudden, loud tones. The present study tested this association in female nurse veterans with PTSD related to witnessing patients' death, severe injury and/or suffering during their Vietnam service. Nurses with current, past but not current, or who never had PTSD listened to 15 consecutive 95-dB, 500-ms, 1000-Hz tones with sudden onsets, while HR, SC, and eyeblink responses were measured. Nurses with current PTSD produced significantly larger averaged HR, but not SC or eyeblink responses across tone trials. A larger HR response to loud tones is one of the most robust physiologic findings in PTSD and may reflect increased defensive responding. [source] | |||||||||||||||||||||||||||||||