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Clinical Findings (clinical + finding)
Kinds of Clinical Findings Selected AbstractsHistological and Clinical Findings in Different Surgical Strategies for Focal Axillary HyperhidrosisDERMATOLOGIC SURGERY, Issue 8 2008FALK G. BECHARA MD INTRODUCTION Although a variety of different surgical strategies for focal axillary hyperhidrosis (FAH) have proven effective, little is known of intraoperative and postoperative histologies of different surgical methods. OBJECTIVE The objective was to use pre-, intra-, and postoperative histologic findings to evaluate different surgical procedures for FAH in establishing a possible correlation between the interventions and clinical outcome. MATERIAL AND METHODS A total of 40 patients underwent surgery with 15 undergoing liposuction-curettage (LC), 14 radical skin excision (RSE) with Y-plasty closure, and 11 a skin-sparing technique (SST). Before surgery, density and ratio of eccrine and apocrine sweat glands were evaluated with routine histology. Further biopsies were taken directly after surgery in the RSE and SST groups and 1 year postoperatively in all patients. Additionally, gravimetry was performed, side effects were documented, and patients were asked to evaluate the aesthetic outcome of the surgical method by using an analogue scale. RESULTS Preoperatively, the mean density of eccrine glands was 11.1/cm2 compared to 16.9/cm2 apocrine glands (apocrine/eccrine ratio, 1.6). Biopsy specimen directly after surgery showed remaining sweat glands in 7/15 (46.7%) LC patients and in 4/11 (36.4%) of the SST patients. One year after surgery, sweat gland density was significantly reduced in the LC (79.1%) and the SST (74.9%) groups. In the RSE group, only scar formation was present. Gravimetry showed significantly reduced sweat rates 12 months after surgery in all groups (LC, 66.4%; SST, 62.9%; RSE, 65.3% [p<.05]). Most frequent side effects were hematoma (LC, n=3; SST, n=2; RSE, n=3), subcutaneous fibrotic bridles (LC, n=8; SST, n=3; RSE, n=0), skin erosion (LC, n=3; SST, n=4; RSE, n=0), focal hair loss (LC, n=9; SST, n=11; RSE, n=14), and paresthesia (LC, n=4; SST, n=3; RSE, n=5). CONCLUSION Histologic distribution and density of sweat glands were comparable to previous studies. All three surgical procedures evaluated are effective in the treatment of FAH. RSE and SST techniques are associated with a higher risk of side effects and cause more extensive scarring. However, one LC patient (n=1; 6.7%) did not respond to treatment. [source] Epidermal Nevus Syndromes: Clinical Findings in 35 PatientsPEDIATRIC DERMATOLOGY, Issue 4 2004Helena Vidaurri-de la Cruz M.D. A predisposition to malignant neoplasms in ectodermal and mesodermal structures may also be found. There are six different epidermal nevus syndromes described so far: Proteus, congenital hemidysplasia with ichthyosiform nevus and limb defect syndrome, phakomatosis pigmentokeratotica, sebaceous nevus, Becker nevus, and nevus comedonicus. Thirty-five patients with epidermal nevus syndrome seen at the National Institute of Pediatrics in Mexico City during a 31-year period are described. This syndrome represented 7.9% of 443 patients with epidermal nevi; its relative frequency was 1 case per 11,928 pediatric patients and 1 case per 1080 dermatologic patients. Nine epidermal nevus syndrome patients (26%) had Proteus syndrome. Sebaceous nevus syndrome was found in six patients (17%), while the nevus comedonicus syndrome was found in three (8%). Two patients were diagnosed with phakomatosis pigmentokeratotica and one patient with congenital hemidysplasia with ichthyosiform nevus and limb defect syndrome. This is the first report of phakomatosis pigmentokeratotica and congenital hemidysplasia with ichthyosiform nevus and limb defect syndrome in Mexican patients. One patient had an inflammatory linear verrucous epidermal nevus with systemic involvement. Thirteen patients (37%) had keratinocytic nevi with systemic involvement. We propose the keratinocytic nevus syndrome to be defined as the association of a keratinocytic nevus with neuronal migration and/or musculoskeletal disorders in addition to a higher risk for mesodermal neoplasms. [source] Clinical findings and outcomes of ulcerative keratomycosis in 30 horses in the mid-Atlantic United States (2006,2007)EQUINE VETERINARY EDUCATION, Issue 1 2010M. E. Utter Summary The purpose of this study was to determine the clinical course and outcome associated with keratomycosis in horses in the mid-Atlantic USA. Records of horses diagnosed with keratomycosis at New Bolton Center from November 2006 to November 2007 with positive fungal culture were retrospectively studied. Neither horses with ulcerative keratitis and a negative fungal culture nor those with stromal abscesses were included. Subject details, history, clinical findings, therapy and outcome were recorded. Thirty horses fitted both inclusion criteria (diagnosis of keratomycosis and positive corneal fungal culture). Fourteen of 30 cases occurred during summer. Aspergillus was the most commonly cultured fungal genus (17/30, or 57%) followed by Alternaria (4/30). Seventeen horses had positive bacterial and fungal cultures. Fifteen of 30 horses were treated surgically by a keratectomy and amnion (8) or conjunctival (7) graft. Itraconazole was the most common topical anti-fungal therapy and was utilised in 25/30 horses. Globe survival was 97% (29/30). All surviving globes had a positive menace response and were visual at the last examination. It was concluded that in the mid-Atlantic USA, fungal keratitis is common, has the highest incidence in summer, and is usually associated with a positive outcome. Aspergillus may be a relatively more common corneal pathogen in this region than elsewhere in the USA. Surgical cases were more likely to have fungal hyphae identified on cytology and tended to be hospitalised longer than medical cases. There was no apparent association between surgical disease and all other patient, organism and treatment variables. [source] Clinical findings, diagnosis, prevalence and predisposing factors for lameness localised to the middle carpal joint in young Standardbred racehorsesEQUINE VETERINARY JOURNAL, Issue 2 2006C. M. Steel Summary Reasons for performing study: Lameness related to the middle carpal joint (MCJ) occurs in up to 30% of young Standardbred horses in race training and the incidence increase with radiographic severity of third carpal bone (C3) sclerosis on DPr-DDIO (skyline) view of the carpus. Factors predisposing horses to carpal injury have not been well investigated. Objectives: To determine the importance of MCJ lameness as a cause of wastage in young Standardbred racehorses, stage of training at which it occurs and predisposing factors, and to describe clinical findings and diagnosis. Methods: Standardbred horses (n = 114) entering their first year of race training were examined at approximately 3-month intervals over 12,18 months. For 87 of the horses, a training diary was available and these horses were trained at 3 different stables, each using a different exercise regime. At each examination, forelimb conformation, MCJ effusion, MCJ lameness and radiographic findings were graded, and training history and reasons for lost training days recorded. Nuclear scintigraphy and exploratory arthroscopy were performed on a limited selection of horses. Results for horses that developed MCJ lameness during the study period were compared statistically with results for horses that did not. Results: Carpal lameness occurred in 28% of horses and was present in 56% with forelimb lameness. In most cases lameness was mild, bilateral and with little or no MCJ effusion and was attributed to subchondral bone pain associated with radiographic evidence of C3 sclerosis. Carpal lameness was the most common reason for >1 month's rest during the study period. It occurred at any stage of training but, in most cases, some speed training had begun. Of the variables studied, poor forelimb conformation and more intense speed training were predisposing factors. Conclusions and potential relevance: The information gained should assist in making recommendations regarding training young Standardbreds to reduce the incidence of MCJ lameness. However, further investigations to determine the optimal training regime are warranted. [source] Diffuse idiopathic skeletal hyperostosis-induced dysphagia or DISHphagiaINTERNATIONAL JOURNAL OF RHEUMATIC DISEASES, Issue 2 2005Salih OZGOCMEN Summary Dysphagia related to osteophyte compression in diffuse idiopathic skeletal hyperostosis (DISH) or Forestier's disease and in cervical spondylosis has been identified as a cause of dysphagia. We report an elderly man who had dysphagia due to DISH or namely DISHphagia. Clinical findings, barium esophagogram, and magnetic resonance imaging findings have been presented. Good response to medical treatment with liquid forms of NSAIDs and soft diet has been achieved. [source] Tungiasis (tungosis) comes to the Czech RepublicJOURNAL OF COSMETIC DERMATOLOGY, Issue 4 2002A Pospí, ilová Summary, A case of a 39 year old patient in whom infection by the sand flea Tunga penetrans was diagnosed by histological examination is described. Clinical findings included small red lesions on the lower extremities, containing a pyodermic component and a central black dot resembling tattoo. A tropical parasitic disease was considered as the signs developed following the patient's return from Tanzania. [source] Fibroblastic rheumatism: fibromatosis rather than non-Langerhans cell histiocytosisJOURNAL OF CUTANEOUS PATHOLOGY, Issue 5 2010Nicolas Kluger Background: Fibroblastic rheumatism is a unique fibro-proliferative disease affecting the skin and joints. It is characterized by distinctive clinical and histological features related to benign spindle-shaped cells proliferation. Pediatric reports are scarce in the literature. Objective: We describe here a new case in a 10-year-old boy and discuss the potential origin of the cell proliferation. Methods: Clinical findings, radiology, microscopic examination and outcome are reviewed. Histopathology and immunochemistry studies were performed on skin biospies using CD68, CD163, desmin, factor XIIIa, CD34, smooth muscle actin, PS100, epithelial membrane antigen, and calponin. Results: Histological sections disclosed a rather circumscribed nonencapsulated nodular infiltrate, invading the dermis and the upper subcutaneous tissue, consisted of a proliferation of spindle or stellate-shaped cells and thickened collagen fibers. Orcein staining showed disappearance of the elastic network. Aponeurosis and muscle were normal. A mild perivascular lymphohistiocytic infiltrate was noted. Calponin-staining was less strongly expressed as SMA, and some of them but not all were CD68 positive, as well. On the other hand, all were CD34, CD163, FXIIIa, PS100, EMA and desmin-negative. Conclusion: The true origin of these cells remains unclear. Some authors have speculated a histiocytic origin. However, immuno-chemical staining in our case failed to confirm this hypothesis and instead supported a fibroblastic/myofibroblastic origin. Given the clinical course and the histological and immunohistochemical results, we suggest that FR should be added to the group of fibromatoses. Kluger N, Dumas-Tesici A, Hamel D, Brousse N, Fraitag S. Fibroblastic rheumatism: fibromatosis rather than non-Langerhans cell histiocytosis. [source] Neuroimaging in Posterior Reversible Encephalopathy SyndromeJOURNAL OF NEUROIMAGING, Issue 2 2004C. Lamy ABSTRACT The terms posterior reversible leukoencephalopathy, reversibleposterior cerebral edema syndrome, and posterior reversibleencephalopathy syndrome(PRES) all refer to a clinicoradiologic entity characterized by headaches, confusion, visual disturbances, seizures, and posterior transient changes on neuroimaging. Clinical findings are not sufficiently specific to readily establish the diagnosis; in contrast, magnetic resonance imaging pattern is often characteristic and represents an essential component of the diagnosis of PRES. Typical lesions predominate in the posterior white matter, with some involvement of the overlying cortex; are hyperintense on T2-weighted images; and are usually hypointense or isointense on diffusion-weighted images, with an increase of the apparent diffusion coefficient, indicating vasogenic edema. The pathogenesis is incompletely understood, although it seems to be related to the breakthrough of autoregulation and endothelial dysfunction. Since its initial description, this syndrome has been subsequently described in an increasing number of medical conditions, including hypertensive encephalopathy, eclampsia, and the use of cytotoxic and immunosuppressive drugs. The diagnosis has important therapeutic and prognostic implications because the reversibility of the clinical and radiologic abnormalities is contingent on the prompt control of blood pressure and/or discontinuing the offending drug. On the contrary, when unrecognized, conversion to irreversible cytotoxic edema may occur. [source] Eruptive syringoma: 27 new cases and review of the literatureJOURNAL OF THE EUROPEAN ACADEMY OF DERMATOLOGY & VENEREOLOGY, Issue 3 2001J Soler-Carrillo Abstract Background Eruptive syringomas are uncommon eccrine sweat gland tumours. Only 64 cases have been reported in the literature. Objective Clinical findings of 27 patients with eruptive syringomas were reviewed over a 47-year period. Results The tumours appeared as multiple yellow,brown-coloured papules localized on the neck, anterior trunk, axillae, shoulders, abdomen or pubic area. This disorder occurs more frequently among women, and is frequent in the prepubertal as well as in the postpubertal age. The diagnosis was not clinically suspected in most cases. Conclusions Eruptive syringomas have to be considered in differential diagnosis of papular dermatosis at any age. [source] Systematic review: portal vein thrombosis in cirrhosisALIMENTARY PHARMACOLOGY & THERAPEUTICS, Issue 3 2010E. A. TSOCHATZIS Aliment Pharmacol Ther 31, 366-374 Summary Background, As current imaging techniques in cirrhosis allow detection of asymptomatic portal vein thrombosis during routine ultrasonography, more patients with cirrhosis are diagnosed with portal vein thrombosis. Although a consensus on noncirrhotic extra-hepatic portal vein thrombosis has been published, no such consensus exists for portal vein thrombosis with cirrhosis. Aim, To perform a systematic review of nonmalignant portal vein thrombosis in cirrhosis in terms of prevalence, pathogenesis, diagnosis, clinical course and management. Methods, Studies were identified by a search strategy using MEDLINE and EMBASE. Results, Portal vein thrombosis is encountered in 10,25% of cirrhotics. In terms of pathophysiology, cirrhosis is no longer considered a hypocoagulable state; rather than a bleeding risk in cirrhosis, various clinical studies support a thrombotic potential. Clinical findings of portal vein thrombosis in cirrhosis vary from asymptomatic disease to a life-threatening condition at first presentation. Optimal management of portal vein thrombosis in cirrhosis is currently not addressed in any consensus publication. Treatment strategies most often include the use of anticoagulation, while thrombectomy and transjugular intrahepatic portosystemic shunts are considered second-line options. Conclusions, Portal vein thrombosis in cirrhosis has many unresolved issues, which are often the critical problems clinicians encounter in their everyday practice. We propose a possible research agenda to address these unresolved issues. [source] The use of clinical findings in the identification of equine peritonitis cases that respond favorably to medical therapyJOURNAL OF VETERINARY EMERGENCY AND CRITICAL CARE, Issue 4 2007DACVECC, DACVS, Louise L. Southwood BVSc Abstract Objective: To compare clinical findings in horses/foals with peritonitis that: (1) had no concurrent (NCA) versus a concurrent abnormality found during hospitalization, (2) survived to discharge versus did not survive to discharge, and (3) survived to discharge without surgery versus did not survive to discharge without surgery. Design: Retrospective study. Setting: George D. Widener Hospital for Large Animals at New Bolton Center. Animals: Horses/foals admitted between 1992 and 2002 with a diagnosis of peritonitis. A diagnosis of peritonitis within 4 days of presentation and peritoneal fluid nucleated cell count >10,000/,L were required for study inclusion. Horses/foals were excluded if the peritonitis was secondary to gastrointestinal or reproductive tract perforation, a complication of exploratory celiotomy, or if peritonitis was not diagnosed until surgery or necropsy. Interventions: None. Measurements and main results: Information obtained from the medical records included clinical findings at presentation and during the initial 4 days of hospitalization. Outcome was defined as: (1) NCA (yes/no), (2) survived to discharge (yes/no), and (3) survived to discharge without surgery (yes/no). Forty-two percent (23/55) of horses/foals had NCA; 78% (43/55) survived to discharge, and 68% (36/55) survived to discharge without surgery. Horses/foals with peritonitis that had any one of the following clinical findings were likely to survive to discharge without surgery: no signs of abdominal pain, normal/improved rectal temperature, normal/improved intestinal borborygmi, normal fecal production, no abnormal findings on abdominal palpation per rectum, no nasogastric reflux, or yellow/orange peritoneal fluid. Conclusion: Clinical findings can be used to identify equine peritonitis cases that will respond favorably to medical therapy. [source] Third-Degree Atrioventricular Block in 21 Cats (1997,2004)JOURNAL OF VETERINARY INTERNAL MEDICINE, Issue 1 2006H.B. Kellum The effect of 3rd-degree atrioventricular block on long-term outcome in cats is unknown. Clinical findings and long-term outcome of 21 cats with 3rd-degree atrioventricular block were studied retrospectively. Median age of cats studied was 14 years (range 7,19 years). Presenting signs included respiratory distress or collapse, but 6 cats had no clinical signs of disease. Eight cats had congestive heart failure (CHF) at the time that 3rd-degree atrioventricular block was detected. Heart rates ranged from 80 to 140 beats per minute (bpm; median 120 bpm) with no difference in heart rate between cats with and those without CHF. Eleven of 18 cats that had echocardiograms had structural cardiac disease, and 6 cats had cardiac changes consistent with concurrent systemic disease. No atrioventricular nodal lesions were detected by echocardiography. One cat had atrioventricular nodal lesions detected on histologic examination. Median survival of 14 cats that died or were euthanized was 386 days (range 1,2,013 days). Survival did not differ between cats with or without CHF or between cats with or without structural cardiac disease. Thirteen cats with 3rd-degree atrioventricular block survived >1 year after diagnosis, regardless of presenting signs or underlying cardiac disease. Third-degree heart block in cats is often not immediately life threatening. Survival was not affected by the presence of underlying heart disease or congestive heart failure at the time of presentation. Even cats with collapse might survive >1 year without pacemaker implantation. [source] Bilastine in allergic rhinoconjunctivitis and urticariaALLERGY, Issue 2010C. Bachert To cite this article: Bachert C, Kuna P, Zuberbier T. Bilastine in allergic rhinoconjunctivitis and urticaria. Allergy 2010; 65 (Suppl. 93): 1,13. Abstract Allergic rhinoconjunctivitis and urticaria are increasing in prevalence in many developed countries. The role of histamine in such conditions is well documented and clinical guidelines recommend non-sedating H1 -receptor antagonists as first-line treatment choices. Bilastine is a novel non-sedating histamine H1 -receptor antagonist developed for the treatment of allergic rhinoconjunctivitis and urticaria. The aim of this review is to critique the scientific evidence relating to the pharmacological properties of bilastine and the clinical evidence regarding its potential as an antihistamine. In vitro binding studies and investigations in animal tissue have demonstrated the high specificity of bilastine for H1 -receptors, and preclinical animal studies have also yielded promising results in terms of a reduction of histamine-mediated inflammatory effects, including capillary permeability and bronchospasm. In pharmacodynamic studies bilastine was found to down-regulate histamine-induced flare and wheal responses in healthy volunteers. Preclinical and clinical pharmacokinetic studies showed that bilastine has dose-dependent kinetics following oral administration. Excretion is almost exclusively via urine and faeces as unchanged drug. Early clinical trials have shown that bilastine has similar efficacy to other second-generation H1 -receptor antagonists such as cetirizine, desloratadine, fexofenadine and levocetirizine, in terms of reducing allergic symptoms. Clinical findings also indicate that bilastine has a rapid onset of action and a 20 mg single dose is effective throughout a 24-h period. Furthermore, bilastine has been associated with improved quality of life in allergic rhinoconjunctivitis and urticaria patients. Adverse effects have generally been minimal in these studies and doses up to twice those proposed did not exhibit differences in adverse events compared to placebo. Moreover, in vivo investigations have found no evidence of accumulation of bilastine in the central nervous system, and various studies have confirmed minimal effects on psychomotor performance in healthy volunteers administered up to four times the usual dose. Clinical studies have also found no effect of bilastine on the QTc interval and other ECG parameters, even at supratherapeutic dosages, confirming the good cardiac safety profile of this newer antihistamine. Given its pharmacodynamic profile, which appears to be similar to other second-generation H1 -receptor antagonists, and its favourable safety and tolerability, bilastine has the attributes of a potentially clinically useful non-sedating antihistamine. Larger clinical studies are now necessary to fully elucidate the clinical potential of this novel antihistamine. [source] Acute inorganic mercury vapor inhalation poisoningPATHOLOGY INTERNATIONAL, Issue 3 2000Sigeyuki Asano Abstract Mercury contamination is a serious environmental problem worldwide. Two primary sources of contamination are dumping of large quantities of inorganic mercury and exposure in the mining industry. Although the actual fatal level of mercury vapor is not known, exposure to more than 1,2 mg/m3 of elemental mercury vapor (Hg0) for a few hours causes acute chemical bronchiolitis and pneumonitis. Two hours after exposure, lung injury appears as hyaline membrane formation, and finally, extensive pulmonary fibrosis occurs. Clinical findings correlate with the duration of exposure, the concentration of mercury, and the survival time after exposure. There is no correlation between pathological findings and the concentration of mercury in the tissues. Necrosis of proximal convoluted tubules may be attributed to the disruption of the enzyme systems of Hg2+ -sulfhydryl compounds. Metallothionein protein (MT), induced by the accumulation of Hg2+ in the kidneys, may play an important role in detoxication after it forms a non-toxic Hg2+ -MT compound. Despite the deposition of mercury in the brain, compared with organic mercury, inorganic mercury did not seem to damage the neurons. Drugs such as chelating agents and corticosteroids appear to effectively decrease the inflammation and delay pulmonary fibrosis. [source] Preconception Health Status of Iraqi Women After Trade EmbargoPUBLIC HEALTH NURSING, Issue 4 2008Wafa Abdul Karim Abbas ABSTRACT Objectives: To describe the preconception health status of Iraqi women in 2001 following the trade embargo imposed on Iraq beginning in 1991 and only partially removed in 1996. Design: A descriptive cross-sectional prevalence study. Sample: 500 Iraqi women at a premarital clinic in Baghdad in 2001. Measurements: Women were surveyed for age, area of residence, menstrual history, household crowding, consanguinity, and a family history of congenital problems. Clinical findings regarding height, weight, and hemoglobin level were included in the data. Results: Almost one third of the women were below the age of 20 and the majority were between 20 and 25 years of age. More than half of the women in this study had an intermediate-level education or less and lived in very crowded housing. Most of the women were anemic and reported a delay in menarche, suggesting malnutrition. Most of the women were planning consanguineous unions even though many reported congenital conditions in their family of origin. Conclusions: Young Iraqi women who endured embargo needed, and continue to need, aggressive preventive health services to recoup health gains lost during the 1990s and to address prevention of common congenital disorders. [source] Sexual Function and Tunica Albuginea Wound Healing Following Penile Fracture: An 18-year Follow-Up Study of 352 Patients from Kermanshah, IranTHE JOURNAL OF SEXUAL MEDICINE, Issue 4 2009Javaad Zargooshi MD ABSTRACT Introduction., We present a study on the experiences of penile fracture in an Iranian population. Aim., To determine the long-term outcome of penile fracture. Methods., Between April 1990 and May 2008, 373 patients presented with clinical features suggestive of penile fracture. Of these, 11 declined surgery. The remaining 362 were operated upon using a degloving incision. Ten patients had venous injury and 352 had penile fracture. At follow-up visits, in addition to answering our questionnaire, the patients completed the International Index of Erectile Function (IIEF), Erection Hardness Grading Scale (EHGS), and global self-assessment of potency (GSAP). To enhance documentation and to promote transparency, with the patients' permission, their full name and hospital chart number was sent to the journal. Main Outcome Measures., Clinical findings and IIEF and EHGS scores. Results., Mean patients' age was 29.6 years. Mean duration of follow-up was 93.6 months. Diagnosis was solely clinical. At presentation, 278 (78.9%) reported no pain. Cavernosography, ultrasonography, or magnetic resonance imaging was not used in any of the patients. Penile fracture was due to taqaandan in 269 patients (76.4%). Patients were treated with surgical exploration and repair within 24 hours of admission, regardless of delay in presentation. A nodule was found at follow-up in 330 patients (93.7%). The painless, mostly proximal nodule was palpated at the floor of the corpora cavernosa, in a deep midline position above the corpus spongiosum. The non-expansive nodule was not associated with erectile dysfunction (ED) or Peyronie's disease. Postoperative complications included mild penile pain in cold weather (two patients), transient wound edema (one patient), mild chordee (four patients), and occasional instability of the erect penis (one patient). Postoperatively, of the 217 patients who had partners, 214 (98.6%) were potent. Mean IIEF ED domain score was 29.8 ± 1.1. The EHGS score was 4 in 203 and 3 in 11. The GSAP score was 0 in 204, 1 in 8, and 2 in 2. ED in the remaining three could not be explained by penile fracture. Of 10 nonoperated patients, eight (80%) developed ED. Conclusion., Pain is rare in penile fracture. Postoperatively, almost all patients develop a permanent, inconsequential, fibrotic nodule. Our time-tested approach provided excellent long-term sexual function. Zargooshi J. Sexual function and tunica albuginea wound healing following penile fracture: An 18-year follow-up study of 352 patients from Kermanshah, Iran. J Sex Med **;**:**,**. [source] Classification of the External Auditory Canal CholesteatomaTHE LARYNGOSCOPE, Issue 3 2005Ramin Naim Abstract Objectives/Hypothesis: The external auditory canal cholesteatoma (EACC) is a rare disease in the field of otolaryngology. Only 1 in 1,000 new otologic patients present with this entity, which was first described by Toynbee. The aim of this article is to classify EACC by different histopathologic and clinical findings of patients presenting to the Department of Otolaryngology at the University of Mannheim, Germany. Methods: From 2000 to 2004, 17 patients presented to our clinic with EACC. The cholesteatoma were treated surgically, and the specimens were investigated histologically. Clinical findings were also recorded. We classified four stages: stage I with hyperplasia of the canal epithelium, stage II including periosteitis, Stage III including a defective bony canal, and stage IV showing an erosion of adjacent anatomic structure. Results: Eight patients presented with stage II, five patients with stage III, three with stage I, and only one patient presented with erosion of the mastoid cells, which was determined as stage IV. Conclusion: In summary, our classification serves to describe the different histopathologic and clinical stages of EACC. [source] Unique Early Gene Expression Patterns in Human Adult-to-Adult Living Donor Liver Grafts Compared to Deceased Donor GraftsAMERICAN JOURNAL OF TRANSPLANTATION, Issue 4 2009J. De Jonge Because of inherent differences between deceased donor (DD) and living donor (LD) liver grafts, we hypothesize that the molecular signatures will be unique, correlating with specific biologic pathways and clinical patterns. Microarray profiles of 63 biopsies in 13 DD and 8 LD liver grafts done at serial time points (procurement, backbench and postreperfusion) were compared between groups using class comparisons, network and biological function analyses. Specific genes were validated by quantitative PCR and immunopathology. Clinical findings were also compared. Following reperfusion, 579 genes in DD grafts and 1324 genes in LDs were differentially expressed (p < 0.005). Many upregulated LD genes were related to regeneration, biosynthesis and cell cycle, and a large number of downregulated genes were linked to hepatic metabolism and energy pathways correlating with posttransplant clinical laboratory findings. There was significant upregulation of inflammatory/immune genes in both DD and LD, each with a distinct pattern. Gene expression patterns of select genes associated with inflammation and regeneration in LD and DD grafts correlated with protein expression. Unique patterns of early gene expression are seen in LD and DD liver grafts, correlating with protein expression and clinical results, demonstrating distinct inflammatory profiles and significant downregulation of metabolic pathways in LD grafts. [source] Clinical findings in congenital absence of the vasa deferentiaANDROLOGIA, Issue 1 2000Dr W.-H. Summary. In a clinical study, 105 patients with congenital bilateral absence of the vas deferens (CBAVD) and 18 with congenital unilateral absence of the vas deferens (CUAVD) were investigated. CUAVD was observed on the left side in 66%. Renal agenesis was more frequent in CUAVD (73.7%) than in CBAVD (11.8%). The leading signs of CBAVD are low pH level (average 6.5) and low volume of the ejaculate (average 0.95 ml). Testicular biopsies of 52 patients revealed normal spermatogenesis or hypospermatogenesis (33% in CBAVD; 45% in CUAVD). Genetic probing and counselling concerning cystic fibrosis are necessary if extracorporal microfertilization is considered. The absence of the vas deferens was often overlooked by the first investigator, the average time until correct diagnosis being 4.3 years. As artificial reproduction technology becomes more common, detection of vasal agenesis will certainly be made earlier and more frequently in the future. In order to assure compatibility of subsequent prospective studies about CBAVD and CUAVD, the following investigations are considered to be necessary: (i) semen analysis (pH, volume); (ii) renal ultrasonography or excretory urogram (screening for renal agenesis); (iii) genetic cystic fibrosis screening. [source] Primary central nervous system vasculitis: analysis of 101 patientsANNALS OF NEUROLOGY, Issue 5 2007Carlo Salvarani MD Objective To analyze the clinical findings, response to therapy, outcome, and incidence of primary central nervous system vasculitis (PCNSV) in a large cohort from a single center Methods We retrospectively studied 101 patients with PCNSV, selected by predetermined diagnostic criteria, who were seen during a 21-year period. This was a collaborative study by five departments at a large multispecialty clinic. Clinical findings and outcomes were compared among patients categorized by method of diagnosis, response to therapy, survival, and degree of disability. An annual incidence rate was calculated Results Seventy patients were diagnosed by angiography and 31 by central nervous system biopsy. Three histological patterns were observed during biopsy. Although most patients responded to therapy, an increased mortality rate was observed. Relapses occurred in one fourth of patients. Mortality rate and disability at last follow-up were greater in those who presented with a focal neurological deficit, cognitive impairment, cerebral infarctions, and angiographic large-vessel involvement but were lower in those with prominent gadolinium-enhanced lesions when evaluated by magnetic resonance imaging. The annual incidence rate of PCNSV was 2.4 cases per 1,000,000 person-years Interpretation PCNSV is a rare disease that may result in serious neurological outcomes or death. Angiography and brain biopsy may complement each other when determining the diagnosis. Early recognition and treatment may reduce poor outcomes. PCNSV is a variable syndrome that appears to consist of several subsets of heterogeneous diseases. Ann Neurol 2007 [source] Prospective Evaluation of Two Clinical Scores for Acute Asthma in Children 18 Months to 7 Years of AgeACADEMIC EMERGENCY MEDICINE, Issue 6 2010FRCPC, Serge Gouin MDCM Abstract Objectives:, The objective was to evaluate the discriminatory ability of two clinical asthma scores, the Preschool Respiratory Assessment Measure (PRAM) and the Pediatric Asthma Severity Score (PASS), during an asthma exacerbation. Methods:, This was a prospective cohort study in an academic pediatric emergency department (ED; 60,000 visits/year) conducted from March 2006 to October 2007. All patients 18 months to 7 years of age who presented for an asthma exacerbation were eligible. The primary outcome was a length of stay (LOS) of >6 hours in the ED or admission to the hospital. Clinical findings and components of the PRAM and the PASS were assessed by a respiratory therapist (RT) at the start of the ED visit and after 90 minutes of treatment. Results:, During the study period, 3,845 patients were seen in the ED for an asthma exacerbation. Of these, 291 were approached to participate, and eight refused. Moderate levels of discrimination were found between a LOS of >6 hours and/or admission and PRAM (area under the receiver-operating characteristic curve [AUC] = 0.69, 95% confidence interval [CI] = 0.59 to 0.79) and PASS (AUC = 0.70, 95% CI = 0.60 to 0.80) as calculated at the start of the ED visit. Significant similar correlations were seen between the physician's judgment of severity and PRAM (r = 0.54, 95% CI = 0.42 to 0.65) and PASS (r = 0.55, 95% CI = 0.43 to 0.65). Conclusions:, The PRAM and PASS clinical asthma scores appear to be measures of asthma severity in children with discriminative properties. ACADEMIC EMERGENCY MEDICINE 2010; 17:598,603 © 2010 by the Society for Academic Emergency Medicine [source] Clinical findings associated with abnormal lung function in children aged 3,26 months with recurrent respiratory symptomsACTA PAEDIATRICA, Issue 8 2010AS Pelkonen Abstract Aim:, To evaluate whether there are any associations between parentally reported symptoms, clinical findings and lung function in young children with recurrent lower respiratory tract symptoms. Methods:, In 2000,2003, 148 children, aged 3,26 months, with recurrent lower respiratory tract symptoms underwent physical examination, investigation of a chest radiograph, whole body plethysmography and skin prick testing to common food and inhalant allergens. Results:, Lung function was considered abnormal (i.e. functional residual capacity z -score of ,1.65 and/or specific conductance z -score of ,,1.65) in 83 (56%) children. Findings of increased work of breathing (p < 0.001) and nonspecific noisy breathing sounds (p < 0.001) in the physical examination, as well as an abnormal chest radiograph (p = 0.028) were independently associated with abnormal lung function, explaining up to 34% of the variation in lung function. In contrast, parentally reported respiratory symptoms, environmental exposures or atopic trait were not associated with lung function abnormalities. Conclusion:, The results of this study emphasize the importance of the meticulous clinical examination in the evaluation of early childhood respiratory disorders. As physical examination alone cannot predict lung function abnormalities reliably in preschool children with troublesome respiratory symptoms, lung function testing may be considered in such patients to obtain additional objective information. [source] Later-onset congenital central hypoventilation syndrome due to a heterozygous 24-polyalanine repeat expansion mutation in the PHOX2B geneACTA PAEDIATRICA, Issue 1 2009Gabriela M Repetto Abstract Aim: to describe a family with later onset congenital central hypoventilation syndrome (LO-CCHS) and heterozygosity for a 24-polyalanine repeat expansion mutation in the PHOX2B gene, rendered phenotypically apparent with exposure to anesthetics. Case summary: An otherwise healthy 2.75-year-old boy presented with alveolar hypoventilation after adenoidectomy and tonsillectomy for obstructive sleep apnea, requiring invasive ventilatory support during sleep. He had a heterozygous 24-polyalanine repeat expansion in the PHOX2B gene (20/24 genotype), a genotype that has not been previously described in association with CCHS or LO-CCHS symptoms. Clinical findings in members of the family with the same 20/24 genotype ranged from asymptomatic to prolonged sedation after benzodiazepines. Conclusion: CCHS should be suspected in individuals presenting with unexplained hypoventilation and/or seizures after anesthetics or sedatives. This is the first report of LO-CCHS in a kindred with the PHOX2B 20/24 genotype. The incomplete penetrance observed in this family suggests a gene,environment interaction. [source] The role of allergic rhinitis in upper respiratory tract inflammatory diseasesCLINICAL & EXPERIMENTAL ALLERGY REVIEWS, Issue 1 2004Y. Kurono Summary The number of patients with allergic rhinitis (AR) is increasing. Furthermore, patients with otitis media with effusion (OME) and chronic sinusitis (CS) are frequently complicated with AR. These findings suggest that AR has an impact on the pathogenesis of both OME and CS. The direct and indirect influence of AR on OME and CS was investigated by clinical and experimental studies to clarify the mechanism by which type I allergic reaction is associated with OME and CS. Clinical findings of patients with OME or CS complicated with AR were analysed and compared with those of nonallergic subjects. Samples such as sinus effusions and middle ear effusions (MEE) were collected from the patients and infiltration of inflammatory cells and concentrations of inflammatory cytokines determined. In addition, previous reports discussing the relationship between AR and OME or CS are reviewed. Eosinophil infiltration and oedema were remarkable in paranasal sinus mucosa of patients with CS complicated with AR, suggesting the presence of type I allergic reaction in sinus mucosa. However, there was little evidence of eosinophils in sinus effusions. Endotoxin was frequently detected in sinus effusions of patients with CS having AR as well as suppurative CS. Hypoxia was also considered an important factor inducing sinus pathology. Eosinophils and IgE antibodies in MEE were not increased in OME patients with AR. Anti-allergic medicine was effective in OME patients complicated with AR and improvement of nasal symptoms significantly correlated with that of ear symptoms. AR might be directly and indirectly associated with the pathogenesis of OME and CS. [source] Spontaneous localized intestinal perforation and intestinal dilatation in very-low-birthweight infantsACTA PAEDIATRICA, Issue 11 2006Tsugumichi Koshinaga Abstract Aim: To elucidate how spontaneous localized intestinal perforation (SLIP) is related to intestinal morphological features such as dilatation in very-low-birthweight (VLBW) infants. Methods: The medical records of 13 VLBW infants (<1500 g) undergoing laparotomy between 1983 and 2003 for presumed SLIP were retrospectively reviewed. Clinical findings including maternal, prenatal and perinatal factors were analysed, and the clinical and surgical findings upon laparotomy were compared. Results: Postnatal pathological conditions included patent ductus arteriosus (n= 7), sepsis (n= 2), respiratory distress syndrome (n= 7), intraventricular haemorrhage (n= 2), an indwelling catheter via the umbilical vein (n= 1) and pneumonia (n= 1). Indomethacin was used in seven neonates with patent ductus arteriosus, and dexamethasone preventive therapy was employed in one neonate for bronchopulmonary dysplasia. Operative findings revealed a localized small punched-out perforation in the ileum. Five patients had intestinal dilatation: two with a perforation in the middle of the dilated intestine, and three with a perforation proximal to the region of dilatation. The muscularis propria was absent in the dilated intestine of four patients. Conclusion: This study found no significant relationship between perforation and dilatation of the intestine. Perforation may occur in any portion of the ischaemic intestine when circulatory failure becomes severe, and is not necessarily restricted to the dilated intestine. We believe that SLIP and intestinal dilatation may occur on the same basis in low-birthweight infants; however, the disease process may be aetiologically different. [source] Cardiogenic Unilateral Pulmonary Edema: An Unreported Complication of a Digestive Endoscopic ProcedureCONGESTIVE HEART FAILURE, Issue 5 2009Enrique M. Baldessari MD Unilateral pulmonary edema is an uncommon clinical situation that may be difficult to distinguish from other conditions that cause lung infiltrates. Most cases occur in the right lung, and there are no reports about cardiogenic unilateral pulmonary edema as a complication of an endoscopic procedure of gastrointestinal tract. The authors describe a case of a 79-year-old woman with acute cardiac heart failure that developed soon after a diagnostic upper and lower digestive endoscopy. Continuous positive airway pressure, intravenous nitroglycerin, and furosemide treatment resulted in rapid improvement of symptoms and the progressive resolution of left-sided infiltrates on chest radiography. This case is of particular importance because of the rarity of cardiogenic unilateral edema in the left lung. This clinical finding was associated with the prolonged rest on the left side during the gastrointestinal endoscopic procedure. [source] Echocardiographic Left Ventricular Mass in African-AmericansECHOCARDIOGRAPHY, Issue 2 2003The Jackson Cohort of the Atherosclerosis Risk in Communities Study Characterization of target organ damage from hypertension is of particular interest in African-Americans, and evidence from electrocardiographic studies suggests that left ventricular hypertrophy is a frequent clinical finding of considerable prognostic importance. Echocardiographic studies may permit more precise characterization of the pathologic impact of hypertension on cardiac structure and function. The objective of this study is to characterize left ventricular (LV) structure including measures of wall thickness, septal thickness, internal dimension, and mass in a middle-aged sample of African-Americans using echocardiography. This study is a cohort (cross-sectional) study in which 2445 middle-aged African-American study participants from a population-based sample initially enrolled by the Atherosclerosis Risk in Communities, Jackson, Mississippi Examination Center in 1987,1989 underwent an M-mode echocardiograpic examination at their third or fourth clinic visit in 1993,1996. Measures of LV mass, even where indexed by size were conspicuously greater in men compared to women, and men exhibited a demonstrably steeper gradient of LV mass across the rather restricted age range of the study. However, when gender specific thresholds for LV hypertrophy were utilized, African-American men appear to have lower prevalence of LV hypertrophy than women. The lowest prevalence of LV hypertrophy was observed in African-American men who did not have hypertension (28.4%). The findings confirm previous suggestions from electrocardiographic investigations that cardiac hypertrophy is common, if not epidemic in middle-aged African-American men and women, whether or not they have hypertension. (ECHOCARDIOGRAPHY, Volume 20, February 2003) [source] Evaluation of a magnetic resonance biomarker of osteoarthritis disease progression: doxycycline slows tibial cartilage loss in the Dunkin Hartley guinea pigINTERNATIONAL JOURNAL OF EXPERIMENTAL PATHOLOGY, Issue 2 2009Jonathan Bowyer Summary The objective was to assess the effect of doxycycline treatment on a magnetic resonance imaging (MRI) biomarker of cartilage volume loss, and on matrix metalloproteinase (MMP) activity in a guinea pig osteoarthritis model. Guinea pigs (9 months old) were dosed with vehicle or doxycycline, 0.6, 3.0 mg/kg/day for 66 days. Fat-suppressed 3D gradient-echo MRI of the left knee was acquired pre- and post dosing. Change in medial tibial plateau (MTP) cartilage volume (MT.VC) was determined using image analysis. At termination, MTP cartilage was removed from knees and proteolytic MMP activity determined using a fluorescent peptide substrate assay. Vehicle-treated animals lost 20.5% (95% CI mean 25.6,15.1) MT.VC. The doxycycline (0.6 mg/kg/day) group lost 8.6% (P < 0.05, 95% CI 20.6 to ,5.3) whilst the 3.0 mg/kg/day group lost 10.0% (P < 0.05, 95% CI 13.9,6.0%). Endogenous levels of active MMPs were below limits of detection in all samples. However, doxycycline treatment ablated amino phenyl mercuric acid activated MMP-13 and MMP-8 levels, reduced MMP-9 levels by 65% and MMP-1 levels by 24%. Doxycycline treatment resulted in partial protection from MT.VC loss and was associated with complete reduction in MMP-13 and MMP-8, and partial reduction in MMP-9 activity. These data imply a role of MMPs in cartilage degeneration but incomplete protection suggests that additional doxycycline insensitive mechanisms are important in this model. The protective effect of doxycycline correlates with the clinical finding of lessened joint space narrowing, strengthens the utility of this animal model in identifying disease-modifying osteoarthritic drugs and supports the use of MRI biomarkers of cartilage loss. [source] Classifying degenerative joint disease by the RDC/TMD and by panoramic imaging: a retrospective analysisJOURNAL OF ORAL REHABILITATION, Issue 3 2010E. WINOCUR Summary, The purposes of the study were to evaluate the utility of diagnosing degenerative joint disease (DJD) by the clinical finding of coarse crepitus alone, without supporting imaging studies, as defined by the RDC/TMD, and to evaluate the contribution of panoramic radiography as an aid in the diagnosis of DJD. A retrospective analysis of 372 consecutive patients with TMD was conducted. Their panoramic radiographs were evaluated for the extent of their contribution to the final diagnosis. Panoramic radiography was of no diagnostic value in 94·4% of the cases when the group was considered as a whole. When patients diagnosed with DJD were considered separately, panoramic radiography was completely sufficient for reaching the final diagnosis in 20·0% of the cases. In almost 90% of these patients, however, the clinical examination did not support the diagnosis of DJD (no coarse crepitus was found). This raises some doubts about the effectiveness of the clinical examination according to the RDC/TMD and about the utility of panoramic radiography in the definitive diagnosis of DJD, because both techniques have low accuracy (11·1% and 20%, respectively). The present study supports the current recommendations that panoramic radiography should not be ordered routinely to assess DJD, but still it is first choice when any dental problem is suspected. Further additional imaging (computerized tomography, magnetic resonance imaging) should be considered only if there is reason to expect that the findings might affect diagnosis and management. This study adds to recent criticisms of the clinical validity of the RDC/TMD, with regard to DJD. [source] PL1 Subepithelial bullous diseases , topic overviewORAL DISEASES, Issue 2006M Mravak-Stipeti Subepithelial bullous diseases comprise the group of mucocutaneous autoimmune blistering diseases characterized by subepithelial separation and the deposition of immunoglobulin and complement against several antigens along the basement membrane zone (BMZ). This result in spectrum of diseases that affect skin, oral mucosa, and other mucosal membranes and include bullous pemphigoid (BP), mucous membrane (cicatricial) pemphigoid (MMP), linear IgA disease (LAD), and chronic bullous dermatosis of childhood (CBDC). The most common clinical features are oral erosions, desquamative gingivitis and conjunctival fibrosis, as well as skin lesions, predominantly in older female population. The heterogeneity of clinical presentation and diversity of target autoantigens have contributed to difficulties in characterizing this condition immunologically. In addition to the clinical presentation and a subepithelial vesicle or bullae on routine histologic analysis, the diagnosis is based on direct and indirect immunofluorescence studies. The nature of the disease is determined by the target antigens in the epithelium and BMZ such as antigen 180 (BP180), antigen 230 (BP230), laminin 5, and beta 4 integrin. Circulating IgG and IgA antibodies bind to different epitopes of BP180. The use of salt-split skin substrate enables differentiation between epidermal and dermal 'binders'. Since the antigen and the antibody titer appear to have direct relationships with the disease severity, and a combination of clinical finding and antibody titer provides valuable prognostic data, these investigations should be carried out routinely. Clinicians should recognize clinical spectrum of SBD, the histopathologic and immunopathologic characteristics, the differential diagnosis, the treatment, and the natural history of the disease. Involvement of oral medicine specialists, dermatologists, ophthalmologists, otolaryngologists and gastroenterologists contribute to early diagnosis and will aid in providing SBD patients with the highest quality of care. [source] | |||||||||||||||||||||||||||||||||||||||||||