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Clinical Cases (clinical + case)
Terms modified by Clinical Cases Selected AbstractsPossible Emergence of Drug-Resistant Variants of Babesia gibsoni in Clinical Cases Treated with Atovaquone and AzithromycinJOURNAL OF VETERINARY INTERNAL MEDICINE, Issue 3 2009M. Sakuma Background: There is no well-established treatment strategy for Babesia gibsoni infection. A new therapeutic protocol using atovaquone (ATV) and azithromycin (AZM) has been proposed, but there is concern about the possible induction of relapse and the emergence of ATV-resistant variants after treatment. Objective: To evaluate the clinical use of combination therapy with ATV and AZM as a first-line treatment of clinical B. gibsoni infection in dogs, and to investigate the emergence of ATV-resistant variants. Animals: Eight B. gibsoni naturally infected dogs showing signs of acute onset of disease. Methods: Retrospective case study. Eight clinical cases received combination therapy with ATV and AZM at Kagoshima University Veterinary Teaching Hospital during 2007,2008, and their clinical courses and clinicopathological parameters were evaluated. In addition, alterations in the cytochrome b (CYTb) gene of B. gibsoni were analyzed by polymerase chain reaction and DNA sequencing techniques. Results: All of the dogs responded well to the treatment, with rapid improvement in their clinical condition and hematological parameters. However, 5 of the 8 dogs relapsed after treatment. Analysis of the CYTb gene strongly suggested the emergence of ATV-resistant variants after treatment. Conclusions and Clinical Importance: The combination of ATV and AZM can be used as a first-line treatment for dogs with babesiosis, but relapses occur. Attention should be paid to the possible in vivo selection of drug-resistant variants. [source] Atlas of Thyroid Surgery: Principles, Practice, and Clinical CasesTHE LARYNGOSCOPE, Issue 7 2009Ryan J. Soose MD No abstract is available for this article. [source] Proximal-type epithelioid sarcoma: case report and result of comparative genomic hybridizationJOURNAL OF CUTANEOUS PATHOLOGY, Issue 1 2004Mi-Woo Lee Background:, Epithelioid sarcoma is a rare mesenchymal neoplasm. Recently, a more aggressive, so-called ,proximal type' epithelioid sarcoma has been described. Clinical case:, A 40-year-old-woman presented with 5 × 4 cm, erythematous, indurated, non-movable, painful mass on the pubic area. Histopathology demonstrated diffuse tumor-cell infiltration into the subcutaneous and fascia, which was consisted of prominent epithelioid cells and scattered rhabdoid cells. A multinodular growth pattern or granulomatous appearance with central necrosis was not observed. The tumor cells showed positive reactions for vimentin, cytokeratin (AE1/AE3), and CD34. Despite the surgery, left inguinal mass with lymphadenopathy occurred one month later. We also carried out comparative genomic hybridization (CGH) with tumor cells. CGH revealed chromosomal gain of 5q32-qter, 12q24-qter, and 22q. Conclusion:, We report a case of proximal-type of epithelioid sarcoma, which showed the chromosomal gains of 5q32-qter, 12q24-qter, and 22q by CGH. [source] Haematology: Clinical cases uncoveredEUROPEAN JOURNAL OF HAEMATOLOGY, Issue 6 2009Ole Weis Bjerrum No abstract is available for this article. [source] A medieval example of a sagittal cleft or ,butterfly' vertebraINTERNATIONAL JOURNAL OF OSTEOARCHAEOLOGY, Issue 6 2003T. Anderson Abstract A mature adult medieval male with a rare congenital anomaly, a sagittal-cleft or butterfly vertebra, is presented. Clinical cases are frequently associated with axial as well as soft-tissue defects. The present case, based only on skeletal evidence, appears to be an isolated finding. The aetiology of the clefting is outlined and palaeopathological evidence for the condition is included. Copyright © 2003 John Wiley & Sons, Ltd. [source] Restoration of Extensive Erosion Areas Using an Indirect Composite TechniqueJOURNAL OF ESTHETIC AND RESTORATIVE DENTISTRY, Issue 1 2000JAMES S. KNIGHT DDS ABSTRACT Cervical erosion defects, particularly those of extensive size that are located in an area where control of the operative field is difficult, can present a significant restorative challenge. This article describes an indirect restorative technique to solve this problem. Following tooth preparation, an indirect restoration is luted to the tooth and the margins are finished and polished. Using an indirect technique minimizes operative field isolation time and the total chairside time required to restore the tooth. Clinical cases are presented to illustrate this technique. CLINICAL SIGNIFICANCE An indirect composite restoration provides a useful treatment option when restoring extensive erosion defects in areas of difficult access. [source] Antibacterial peptides: basic facts and emerging conceptsJOURNAL OF INTERNAL MEDICINE, Issue 3 2003H. G. Boman Abstract., Boman HG (Microbiology and Tumor Biology Center, Karolinska Institutet, Stockholm, Sweden). Antibacterial peptides: basic facts and emerging concepts (Review). J Intern Med 2003; 254: 197,215. Antibacterial peptides are the effector molecules of innate immunity. Generally they contain 15,45 amino acid residues and the net charge is positive. The cecropin type of linear peptides without cysteine were found first in insects, whilst the defensin type with three disulphide bridges were found in rabbit granulocytes. Now a database stores more than 800 sequences of antibacterial peptides and proteins from the animal and plant kingdoms. Generally, each species has 15,40 peptides made from genes, which code for only one precursor. The dominating targets are bacterial membranes and the killing reaction must be faster than the growth rate of the bacteria. Some antibacterial peptides are clearly multifunctional and an attempt to predict this property from the hydrophobicity of all amino acid side chains are given. Gene structures and biosynthesis are known both in the fruit fly Drosophila and several mammals. Humans need two classes of defensins and the cathelicidin-derived linear peptide LL-37. Clinical cases show that deficiencies in these peptides give severe symptoms. Examples given are morbus Kostmann and atopic allergy. Several antibacterial peptides are being developed as drugs. [source] Thrombotic Endocarditis in 10 AlpacasJOURNAL OF VETERINARY INTERNAL MEDICINE, Issue 2 2008A.M. Firshman Background: A description of the clinical signs and necropsy findings in 10 alpacas with thrombotic endocarditis. Animals: Clinical cases admitted to 2 veterinary referral hospitals between May 1998 and December 2006. Methods: A retrospective study was performed by searching hospital records to identify alpacas diagnosed with endocarditis. Results: Common clinical findings included sternal recumbency, tachycardia, tachypnea, and abdominal distension. Heart sounds were recorded as normal in 7 of 10 alpacas. Pleural and pericardial effusion and ascites were often present. Complete blood cell counts often suggested inflammation, and liver enzyme activity was often increased. When echocardiography was performed, a soft tissue density was imaged within the right ventricle. All alpacas died or were euthanized. Necropsy revealed mural endocarditis with right ventricular or biventricular fibrinous thrombi obliterating the ventricular lumina with no valvular involvement in 6 of 10 affected animals. Bacteria were not consistently identified as a cause for the endocarditic lesions. Eight of the 10 alpacas had evidence of hepatic fluke infestation. Conclusions and Clinical Importance: Valvular and mural thrombotic endocarditis should be included in the list of differential diagnoses for hepatomegaly, abdominal distension, and other signs of right-sided congestive heart failure in alpacas. The prognosis of this disease is grave. [source] P58 Multisensitization to plants: clinical caseCONTACT DERMATITIS, Issue 3 2004António Luís Santos We observed a 65 years old male patient with pruritus, scaling erythema and liquenification areas on the face, neck, forearms and hands. For six years he had a story of episodic crisis of exsudative erythema associated with farm work. The skin biopsy showed irregular acantosis with slight hyperkeratosis and a mild multifocal lymphohistiocytic infiltrate, with many eosinophils. The patch tests with the Contact Dermatitis Portuguese Group of Study standard tray were positive for colophony, perfume mix and lactone mix. The patch tests with plant series were positive to atranorin, usnic acid, alantolactone, Parthenolide, lichen mix, Frulania dilatata, Achillea millefolium and Tanacetum extracts. Treatment was started with oral prednisone and hydroxyzine plus topical hydrocortisone and emollient cream with great improvement. The patient was advised about the avoidance of possible allergens sources. This kind of multisensitization to plants is an uncommon finding and poses diagnostic and therapeutic problems. This patient had a sustained recovery by avoiding farm work and by removal of in house plants. [source] Repair of untreated horizontal root fracture: a case reportDENTAL TRAUMATOLOGY, Issue 5 2003Murat Özbek Abstract ,,,We report a clinical case of horizontal root fracture in the mandibular first premolar induced by a traffic accident. The fractured tooth spontaneously healed and diagnosed radiographically after 2 years. Fractured fragments were separated by a narrow radiolucent line and the edges were rounded, and healing of the tooth is likely to be related to interproximal connective tissue healing. Our case is an example of spontaneously healed fracture roots. An interesting finding is that the healing was observed even in the presence of two root canals, the vitality of the pulp was preserved and displacement of fragments were prevented. [source] Repair characteristics of horizontal root fracture: a case reportDENTAL TRAUMATOLOGY, Issue 2 2002Wilson Roberto Poi Abstract ,,,Radicular fractures in permanent teeth are uncommon injuries among dental traumas, comprising 0.5,7% of the cases. Fracture occurs most often in the middle-third of the root and rarely at the apical-third. The present paper reports a clinical case of a horizontal radicular fracture located between the middle- and apical-third of a upper left-central incisor followed-up for over 3 years. The tooth was extracted owing to periodontal reasons. Histomorphologically, it showed pulp-vitality preservation and root healing by hard-tissue deposition. [source] A case of small-cell gastric carcinoma with an adenocarcinoma component and hepatic metastases: treatment with systemic and intra-hepatic chemotherapyEUROPEAN JOURNAL OF CANCER CARE, Issue 5 2007T. CIOPPA md Primary small-cell carcinoma (SmCC) of the stomach is a rare neoplasm with a poor prognosis and unclear histogenesis: to date, only 50 cases, including ours, have been reported in the literature. In the World Health Organization gastrointestinal tumours' classification, SmCC of the stomach has been recognized as an ,independent entity affecting the stomach'. In this paper, the authors present a clinical case and the surgical treatment of an adult with a SmCC of the stomach associated with gastric adenocarcinoma. After laparotomy, a large neoplasm with locoregional extension and multiple liver metastases were found. A palliative resection, subtotal gastrectomy, was performed, followed by systemic and intra-hepatic chemotherapy: computed tomography scan demonstrated a marked response, but the patient died 15 months after the operation. A review of the literature showed that the diagnosis of gastric SmCC is based on immunohistochemical findings. Our experience confirmed the high aggressiveness of this neoplasm, which is generally diagnosed in advanced stage and is unresponsive to chemotherapy, but the combined use of systemic and intra-hepatic chemotherapy shows an acceptable result in a palliative care perspective. [source] Apical surgery of a maxillary molar creating a maxillary sinus window using ultrasonics: a clinical caseINTERNATIONAL ENDODONTIC JOURNAL, Issue 11 2010B. García García B, Peñarrocha M, Peñarrocha MA, von Arx T. Apical surgery of a maxillary molar creating a maxillary sinus window using ultrasonics: a clinical case. International Endodontic Journal, 43, 1054,1061, 2010. Abstract Aim, To describe a method of carrying out apical surgery of a maxillary molar using ultrasonics to create a lateral sinus window into the maxillary sinus and an endoscope to enhance visibility during surgery. Summary, A 37-year-old female patient presented with tenderness to percussion of the maxillary second right molar. Root canal treatment had been undertaken, and the tooth restored with a metal-ceramic crown. Radiological examination revealed an apical radiolucency in close proximity to the maxillary sinus. Apical surgery of the molar was performed through the maxillary sinus, using ultrasonics for the osteotomy, creating a window in the lateral wall of the maxillary sinus. During surgery, the lining of the sinus was exposed and elevated without perforation. The root-end was resected using a round tungsten carbide drill, and the root-end cavity was prepared with ultrasonic retrotips. Root-end filling was accomplished with MTA®. An endoscope was used to examine the cut root face, the prepared cavity and the root-end filling. No intraoperative or postoperative complications were observed. At the 12-month follow-up, the tooth had no clinical signs or symptoms, and the radiograph demonstrated progressing resolution of the radiolucency. Key learning points ,,When conventional root canal retreatment cannot be performed or has failed, apical surgery may be considered, even in maxillary molars with roots in close proximity to the maxillary sinus. ,,Ultrasonic sinus window preparation allows more control and can minimize perforation of the sinus membrane when compared with conventional rotary drilling techniques. ,,The endoscope enhances visibility during endodontic surgery, thus improving the quality of the case. [source] Step-wise treatment of two periodontal-endodontic lesions in a heavy smokerINTERNATIONAL ENDODONTIC JOURNAL, Issue 11 2008C. Walter Abstract Aim, To report a clinical case of two advanced periodontal-endodontic lesions with a focus on treatment issues related to tobacco use. Summary, A 53-year-old Caucasian male was referred to the School of Dentistry, Basel, Switzerland, for periodontal treatment. The major diagnoses were chronic (smoker) periodontitis and advanced combined periodontal-endodontic lesions on the mandibular left lateral incisor and right incisor. Conventional root canal treatment was performed, and subsequently led to reduced radiolucencies around the affected roots after 14 months. The remaining osseous defect was augmented by guided tissue regeneration using bovine bone substitute and resorbable membrane. The follow-up revealed a stable situation from clinical (probing depth 2,4 mm) and radiological points of view 32 months after initiation of treatment. Treatment considerations related to tobacco use are discussed. Key learning points, ,,After conventional root canal treatment, osseous healing should occur before further complementary therapy is taken into account. ,,Issues related to tobacco use have to be considered before treatment is initiated. [source] Cutaneous paragonimiasis with flare up after treatment: A clinical case from LaosINTERNATIONAL JOURNAL OF DERMATOLOGY, Issue 9 2006E. Clyti MD No abstract is available for this article. [source] Evidence-based meta-analysis of pharmacotherapy for benign prostatic hypertrophyINTERNATIONAL JOURNAL OF UROLOGY, Issue 11 2002Osamu Ishizuka Abstract Evidence-based diagnosis and treatment have been proposed recently in various medical fields. Evidence-based diagnostic and therapeutic guidelines for benign prostatic hypertrophy (BPH), one of the most common urological diseases, have been proposed in foreign countries. This paper examines common therapeutic drugs for BPH in Japan from the viewpoint of evidence-based medicine (EBM). The term ,BPH' and drugs indicated for BPH were used as key words to search related articles in the PubMed website. A total of 813 articles extracted as of October 2001 were examined. The articles were ranked in levels ranging from I,V, where Level I indicated a large randomized controlled trial and Level V indicated a non-controlled case accumulation study. Among the 813 articles extracted, 132 clinical articles were suitable for evaluation. There were many reliable articles on the effectiveness of ,-blockers. However, it seemed necessary to examine further how to choose the optimum ,-blocker for each clinical case and the combination of antiandrogen drugs with ,-blockers. It was also considered necessary to evaluate the effectiveness of drugs, such as eviprostat and hachimi-jio-gan, that are available only in Japan. The present study evaluated the effectiveness of commonly available therapeutic drugs for BPH in Japan from a viewpoint of EBM. [source] Psychotherapy in Argentina: A clinical case from an integrative perspectiveJOURNAL OF CLINICAL PSYCHOLOGY, Issue 8 2007Beatriz GómezArticle first published online: 29 JUN 200 The article describes psychotherapy practice in Argentina. It outlines the main features of training and regulation of clinical psychologists. A brief description of the main treatment approaches and the major current challenges is presented. Subsequently it delineates the probable treatment locations and options for a 30-year-old woman, Mrs. A, seeking psychological help in Argentina. The case is then considered from an integrative perspective starting with the intake process, which includes a comprehensive pretreatment assessment followed by the treatment plan. Its course is described as composed of four stages: (1) psychoeducational initial intervention, (2) psychotherapy for symptom alleviation, (3) marital treatment, and (4) psychoeducational final intervention. Posttreatment evaluation and possible outcome and prognosis are presented, as well as factors that might prevent improvment. The article ends with a hopeful view of the future role of psychotherapy in Argentina. © 2007 Wiley Periodicals, Inc. J Clin Psychol: In Session 63: 713,723, 2007. [source] An integrative formulation-based cognitive treatment of bipolar disorders: Application and illustrationJOURNAL OF CLINICAL PSYCHOLOGY, Issue 5 2007Warren Mansell An integrative cognitive treatment for mood swings and bipolar disorders is summarized and then illustrated in a clinical case. In essence, it is proposed that multiple, extreme, and conflicting beliefs about changes in internal state, and the reciprocal impact of these beliefs on behavior, physiology, and the social environment, constitute the central mechanism that maintain and escalate bipolar symptoms. Using a case illustration with examples of therapy dialogue, several key aspects of cognitive-behavioral therapy are explained, including the assessment of mood, beliefs, distressing imagery, and recurrent thinking; case formulation; therapeutic techniques; self-awareness; interpersonal factors during therapy; and systemic issues. © 2007 Wiley Periodicals, Inc. J Clin Psychol: In Session 63: 447,461, 2007. [source] Ceramic Inlays and Onlays: Clinical Procedures for Predictable ResultsJOURNAL OF ESTHETIC AND RESTORATIVE DENTISTRY, Issue 6 2003ALFREDO MEYER FILHO DDS ABSTRACT The use of ceramics as restorative materials has increased substantially in the past two decades. This trend can be attributed to the greater interest of patients and dentists in this esthetic and long-lasting material, and to the ability to effectively bond metal-free ceramic restorations to tooth structure using acid-etch techniques and adhesive cements. The purpose of this article is to review the pertinent literature on ceramic systems, direct internal buildup materials, and adhesive cements. Current clinical procedures for the planning, preparation, impression, and bonding of ceramic inlays and onlays are also briefly reviewed. A representative clinical case is presented, illustrating the technique. CLINICAL SIGNIFICANCE When posterior teeth are weakened owing to the need for wide cavity preparations, the success of direct resin-based composites is compromised. In these clinical situations, ceramic inlays/onlays can be used to achieve esthetic, durable, and biologically compatible posterior restorations. [source] Diagnosis and Management of Maxillary Incisors Affected by Incisal Wear: An Interdisciplinary Case ReportJOURNAL OF ESTHETIC AND RESTORATIVE DENTISTRY, Issue 6 2002JUSSARA KARINA BERNARDON ABSTRACT In the attempt to restore anterior teeth affected by erosion and bruxism, many clinicians have been frustrated with the constant restorative failures. Frequently, these failures are attributed to the restorative materials employed, especially in cases in which composite resins are used. However, some flaws of the restorations are related to the oversight of occlusal principles. The purpose of this article is to discuss the etiology, signs, and symptoms of incisal wear, with special attention to that caused by bruxism and chemical erosion. Relatively simple management techniques (e.g., occlusal adjustment, adhesive restorations) are proposed, and the diagnosis and management of a representative clinical case is presented. [source] Training psychiatric teams to do family systems acute psychiatryJOURNAL OF FAMILY THERAPY, Issue 1 2007Jochen Schweitzer This article presents an account of a comprehensive eighteen-day, multi-team, multidisciplinary training approach to family systems inpatient acute psychiatry. It has been developed and tested as part of the SYMPA project (systems therapy in acute psychiatry), which aims to establish systemic case conceptualizations and interventions as routine practice in acute psychiatry. Content, didactic characteristics and specifications of this training are discussed. To illustrate the practical implementation of the training, specifically designed exercises are described and a clinical case is included. The article concludes by presenting first results of the research on implementation indicating that the training had a significant impact on the quantity and quality of conversations with patients. [source] Radiation therapy for intractable bleeding in extremity arteriovenous malformation: Considerations on a clinical caseJOURNAL OF MEDICAL IMAGING AND RADIATION ONCOLOGY, Issue 3 2009JS Goda Summary Arteriovenous malformations are rare clinicopathological entities with varied distribution and a constellation of symptoms. In the extremities they are usually associated with dermatological manifestations, such as angiodermatitis with a potential risk of torrential haemorrhage. Surgical resection is a morbid procedure. Transcatheter embolization and sclerotherapy is an attractive alternative to surgical resection. However, proper case selection is a prerequisite and may not be possible in all the cases. The case reported here is a paradigm of a complex and extensive vascular malformation with torrential haemorrhage where a unique therapeutic approach of radiation therapy was used as an alternative to morbid surgery after embolization and sclerotherapy failure. [source] Is there an easier way to autograft skin in chronic leg ulcers? ,Minced micrografts', a new techniqueJOURNAL OF THE EUROPEAN ACADEMY OF DERMATOLOGY & VENEREOLOGY, Issue 10 2008P Boggio Abstract Background Chronic venous leg ulcers represent an urgent and increasing problem for public health. The use of skin autografts results in a greater therapeutic success in healing chronic ulcers. Objective A simple method of skin autografting that could permit a wider use of skin grafts in outpatients is needed. A new technique allowing skin autografting in a simple one-step process, without complex surgical procedures or expensive technical supplies, is presented. Methods A small, full-thickness skin specimen taken from the patient is finely minced and spread on his leg ulcer bed allowing to cover a surface many times wider than the sample itself. Results This method induces faster re-epithelization of chronic leg ulcers that failed to heal despite good conservative local therapy and give the possibility to repair very large ulcers with small fragments of skin. A clinical case is shown as an example out of 20 ulcers we recently treated. Conclusion Our preliminary report shows that this technique results in a greater therapeutic success (18 of 20 cases) in healing chronic leg ulcers, a common pathology that often affects outpatients treated for very long periods at home or in the Dermatologist's office. In our experience, this new and successful reparative possibility makes ,mince grafting' a recommendable procedure. [source] Use of a structured interview to assess portfolio-based learningMEDICAL EDUCATION, Issue 9 2008Vanessa C Burch Context, Portfolio-based learning is a popular educational tool usually examined by document review which is sometimes accompanied by an oral examination. This labour-intensive assessment method prohibits its use in the resource-constrained settings typical of developing countries. Objectives, We aimed to determine the feasibility and internal consistency of a portfolio-based structured interview and its impact on student learning behaviour. Methods, Year 4 medical students (n = 181) recorded 25 patient encounters during a 14-week medical clerkship. Portfolios were examined in a 30-minute, single-examiner interview in which four randomly selected cases were discussed. Six standard questions were used to guide examiners in determining the ability of candidates to interpret and synthesise clinical data gathered during patient encounters. Examiners were trained to score responses using a global rating scale. Pearson's correlation co-efficient, Cronbach's , coefficient and the standard error of measurement (SEM) of the assessment tool were determined. The number of students completing more than the required number of portfolio entries was also recorded. Results, The mean (± standard deviation [SD], 95% confidence interval [CI]) interview score was 67.5% (SD ± 10.5, 95% CI 66.0,69.1). The correlation coefficients for the interview compared with other component examinations of the assessment process were: multiple-choice question (MCQ) examination 0.42; clinical case-based examination 0.37; in-course global rating 0.08, and overall final score 0.54. Cronbach's , coefficient was 0.88 and the SEM was 3.6. Of 181 students, 45.3% completed more than 25 portfolio entries. Conclusions, Portfolio assessment using a 30-minute structured interview is a feasible, internally consistent assessment method that requires less examination time per candidate relative to methods described in published work and which may encourage desirable student learning behaviour. [source] Role of Biphosphonates and Lymphatic Drainage Type Leduc in the Complex Regional Pain Syndrome (Shoulder,Hand Syndrome)PAIN MEDICINE, Issue 1 2009Andrea Santamato MD ABSTRACT Background., Complex regional pain syndrome (CRPS) is a clinical entity that has been termed in numerous ways in the last years. Clinically, CRPS describes an array of painful conditions that are characterized by a continuing (spontaneous and/or evoked) regional pain that is seemingly disproportionate in time or degree to the usual course of any known trauma or other lesion. The pain is regional and usually has a distal predominance of abnormal sensory, motor, sudomotor, vasomotor, and/or trophic findings. Design., Case report. Setting., University Medical Center. Patients., In this report, we described the case of a 68-year-old hemiplegic female affected by cerebrovascular accident that presented a clinical case of CRPS shoulder,hand syndrome (CRPS-SHS) at the right hand after a hemorrhagic stroke. Interventions., This report evaluated the effects of biphosphonates and lymphatic drainage type Leduc in CRPS-SHS. Outcome Measures., The pain level of the patients was measured with the visual analog scale. A scoring system for the clinical severity of CRPS-SHS, laboratory tests, and X-ray films were also performed. Results., We reported in this patient a great improvement of pain and edema of the right hand, with a significant reduction of bone demineralization. Conclusions., This combined treatment may be a viable alternative for this syndrome; however, further investigation is needed to determine its reproducibility in large case series. [source] Low incidence of hepatic veno-occlusive disease in pediatric patients undergoing hematopoietic stem cell transplantation attributed to a combination of intravenous heparin, oral glutamine, and ursodiol at a single transplant institutionPEDIATRIC TRANSPLANTATION, Issue 5 2010Sonali Lakshminarayanan Lakshminarayanan S, Sahdev I, Goyal M, Vlachos A, Atlas M, Lipton JM. Low incidence of hepatic veno-occlusive disease in pediatric patients undergoing hematopoietic stem cell transplantation attributed to a combination of intravenous heparin, oral glutamine, and ursodiol at a single transplant institution. Pediatr Transplantation 2010: 14:618,621. © 2009 John Wiley & Sons A/S. Abstract:, We report the low incidence of hepatic VOD in pediatric patients with various diagnoses including hematologic malignancies and non-malignant conditions transplanted at our institution. Retrospective review of 188 patients who underwent HSCT and received a combined prophylactic regimen of intravenous heparin, oral glutamine, and ursodiol was undertaken. Analysis of the outcome of VOD revealed only one clinical case with acute myeloid leukemia; the patient developed hepatic VOD 10 days after receiving myeloablative chemotherapy with busulfan and CTX followed by HLA-matched related peripheral blood stem cell transplantation. The low incidence of hepatic VOD in an otherwise high-risk pediatric transplant population is an important observation, which may be partly attributed to this prophylactic regimen, and warrants further randomized clinical trials for confirmation. [source] Analytic impasse and the third: Clinical implications of intersubjectivity theoryTHE INTERNATIONAL JOURNAL OF PSYCHOANALYSIS, Issue 2 2006LEWIS ARON The author examines the notion of the third within contemporary intersubjectivity theory. He utilizes a variety of metaphors (the triangle, the seesaw, strange attractors, and the compass) in an effort to explain this often misunderstood concept in a clear and readily usable manner. An argument is made to the effect that intersubjectivity theory has direct implications for clinical practice, and that the notion of the third is particularly useful in understanding what happens in and in resolving clinical impasses and stalemates. Specifi cally, the author suggests that certain forms of self-disclosure are best understood as attempts to create a third point of reference, thus opening up psychic space for self-refl ection and mentalization. He provides a clinical case as well as a number of briefer vignettes to illustrate the theoretical concepts and to suggest specifi c modifi cations of the psychoanalyst's stance that give the patient greater access to the inner workings of the analyst's mind. This introduces a third that facilitates the gradual transformation from relations of complementarity to relations of mutuality. [source] Theoretical and technical approaches to the clinical case: Advantages and disadvantages of present-day pluralism,THE INTERNATIONAL JOURNAL OF PSYCHOANALYSIS, Issue 6 2004ALAN D. FELIX First page of article [source] Freudian and Lacanian approaches to the clinical case: Listening, interpretation, transference and countertransference,THE INTERNATIONAL JOURNAL OF PSYCHOANALYSIS, Issue 5 2004MARDY S. IRELAND First page of article [source] Psychoanalytic and cognitive approaches to a clinical case,THE INTERNATIONAL JOURNAL OF PSYCHOANALYSIS, Issue 4 2004HUGO BLEICHMAR First page of article [source] | ||||||||||||||||||||||||||||||||||||||||