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Frequent Symptoms (frequent + symptom)
Selected AbstractsNight time eating: a review of the literatureEUROPEAN EATING DISORDERS REVIEW, Issue 1 2003Martina de Zwaan Abstract This study reviews the published research on night time eating, including the night eating syndrome (NES) and the nocturnal eating/drinking syndrome (NEDS). Studies were identified by a computerized literature search (PubMed, PsycInfo) and by references from the papers obtained. In addition, published abstracts from recent conferences in the areas of eating disorders and obesity were included. Individual studies were reviewed and their results summarized. Wakeful night time eating appears to be a frequent symptom which is more common among the obese. The data suggest an early age of onset with a chronic course in many patients. There appears to be considerable overlap between NES and NEDS. Treatment studies are sparse. The clinical features of these syndromes, their comorbidities, and their prevalence rates remain a matter of debate. It is unclear if the night eating syndrome presents a distinct entity that is of clinical relevance. The current nosologies may not capture the natural clustering of eating and sleep-related pathology as it occurs in general population samples. Copyright © 2003 John Wiley & Sons, Ltd and Eating Disorders Association. [source] Etiology and Distribution of Headaches in Two Brazilian Primary Care UnitsHEADACHE, Issue 3 2000Marcelo E. Bigal MD Objectives.,To determine (a) which patients seek primary care services with a complaint of headache, (b) the percentages of the various types of headache in this population, and (c) the impact of the care provided to these patients on the basic health care network. Background.,Headache is one of the most frequent symptoms reported in medical practice, resulting in significant medical services costs and loss of patient productivity, as well as reduced quality of life. Methods.,A prospective study was conducted in two towns (Ribeirão Preto and São Carlos) in the State of São Paulo, Brazil. The participants in the study consisted of 6006 patients (52.4% women) with highly varied acute symptoms. The patients ranged in age from 14 to 98 years. Results.,Headache as the main complaint was reported by 561 (9.3%) of the patients considered, with 312 (55.6%) of those patients presenting with primary headache, 221 (39.4%) with headaches secondary to systemic disorders, and 28 (5.0%) with headaches secondary to neurological disorders. Migraine, the most prevalent primary headache, accounted for 45.1% of patients reporting headache as the single symptom. The most frequent etiologies of headaches secondary to systemic disorders were fever, acute hypertension, and sinusitis. The most frequent headaches secondary to neurological disorders were posttraumatic headaches, headaches secondary to cervical disease, and expansive intracranial processes. Of the 26 cases of drug abuse, 20 were secondary to alcohol (hangover). Headaches secondary to systemic disorders were more frequent in the extreme age ranges. Conclusions.,Headache is a very frequent symptom among patients seen at primary health care units and should be considered a public health problem. The dissemination of the diagnostic criteria of the International Headache Society among primary health care physicians is urgently needed in order to avoid the repeated return of patients or their referral to more differentiated emergency units, which overburden an already insufficient health care network. [source] Clinical presentation and prognosis of childhood Guillain,Barré syndromeJOURNAL OF PAEDIATRICS AND CHILD HEALTH, Issue 7-8 2008Jung Hwan Lee Aim: Guillain,Barré syndrome (GBS) is an acute inflammatory polyneuropathy commonly characterised by rapidly progressive, symmetric weakness and areflexia. This study is to assess the clinical characteristics of paediatric GBS, as well as its long-term functional prognosis. Methods: We retrospectively assessed the clinical manifestations, results of electrodiagnostic tests, functional status and prognosis of 56 children diagnosed with GBS. Based on clinical and electrophysiological findings, the patients were classified as having acute inflammatory demyelinating polyradiculoneuropathy ([AIDP]n = 34), acute motor axonal neuropathy ([AMAN]n = 14), acute motor and sensory axonal neuropathy (n = 1) and Miller Fisher syndrome ([MFS]n = 7). Results: Upper respiratory infection was the most frequent preceding event, and limb weakness was the most frequent symptom at GBS onset. There was no significant difference in the mean time from the onset of illness to nadir between any of these groups. Both the AIDP and AMAN groups showed significantly poorer functional status, measured by the Hughes scale, than the MFS group. Two years after nadir, however, the three groups did not differ significantly. Functional status at nadir, as estimated by the Hughes scale, is a more important factor than electrophysiological types in predicting long-term outcome. Conclusion: The most common symptom at onset in paediatric GBS was limb weakness. Functional status at nadir in AMAN was not significantly different from that of AIDP, and both types achieved good functional outcome for ambulation after 2 years. Functional status at nadir was more important than the electrophysiological type in predicting long-term outcomes. [source] Excessive daytime sleepiness in patients suffering from different levels of obstructive sleep apnoea syndromeJOURNAL OF SLEEP RESEARCH, Issue 3 2000Sauter Excessive daytime sleepiness (EDS) is a frequent symptom of patients with obstructive sleep apnoea (OSA). EDS is a high-risk factor for accidents at work and on the road. Thirty untreated patients with different levels of severity of OSA were studied concerning night sleep and EDS. The criterion for severity was the respiratory disturbance index (RDI): 15 patients were classified as ,moderately' apnoeic (RDI < 40), 15 as ,severely' apnoeic (RDI > 40). Following night-time polysomnography, objective and subjective aspects of EDS were studied. To assess objective EDS the Maintenance of Wakefulness Test (MWT) and a computer-based vigilance performance test were used. Subjective EDS was determined using the Stanford Sleepiness Scale (SSS), the Epworth Sleepiness Scale (ESS) and the Visual Analogue Scales for Performance (VAS-P) and Tiredness (VAS-T). Well-being was assessed using the Scale of Well-Being by von Zerssen (Bf-S/Bf-S,). Severe apnoea patients spent more time in stage 1 and less in slow-wave sleep. MWT latencies tended to be shorter in the severe apnoea group. Vigilance testing revealed no group differences. Patients with moderate apnoea described themselves as more impaired in all subjective scales, but only SSS scores reached statistical significance. Our results suggest that there is no simple correlation between polysomnographic and respiratory sleep variables at night on the one hand, and the extent of EDS on the other hand. Furthermore, subjective and objective evaluation of EDS does not yield the same results. New approaches which allow a more detailed analysis of night sleep and daytime function are required to identify high-risked patients. [source] Double-blind, placebo-controlled study to evaluate the efficacy and safety of botulinum toxin type A in the treatment of drooling in parkinsonismMOVEMENT DISORDERS, Issue 6 2003Francesca Mancini MD Abstract Drooling is a frequent symptom in Parkinson's disease (PD), occurring in almost 75% of all patients. Although it is now well known that drooling in PD is the result of swallowing difficulties rather than excessive saliva production, few treatments have been developed to reduce it. Clinical studies suggest that botulinum toxin A (BTX) injections into salivary glands are effective in decreasing drooling in PD patients. In this double-blind, placebo-controlled study, 20 patients with parkinsonism (idiopathic PD or multiple system atrophy), were randomly assigned to receive 450 U of BTX (Dysport; Ipsen, Berkshire, UK) or 2 ml of placebo, injected into the parotids and submandibular glands under ultrasonographic guidance. Treatment efficacy and safety were assessed at baseline, 1 week and 3 months after BTX injections using clinical scales (Drooling Severity and Drooling Frequency scales) and side effects surveillance. After treatment, the average secretion of saliva in the BTX group was significantly lower than in the placebo group, as appraised by clinical measurements. No side effects were observed in either group. BTX injection into parotids and submandibular glands, under ultrasonographic guidance, is an effective and safe treatment for drooling in parkinsonism. © 2003 Movement Disorder Society [source] Symptom experience associated with immunosuppressive drugs after liver transplantation in adults: possible relationship with medication non-compliance?CLINICAL TRANSPLANTATION, Issue 6 2008G. Drent Abstract:, Symptom experience (occurrence and perceived distress) associated with side effects of immunosuppressive medications in organ transplant patients may well be associated with poorer quality of life and medication non-compliance. The aims of this study were: first, to assess symptom experience in clinically stable adult patients during long-term follow-up after liver transplantation; and second, to study the relationship between symptom experience and medication non-compliance. This cross-sectional study included 123 liver transplant patients. Symptom experience was assessed using the "Modified Transplant Symptom Occurrence and Symptom Distress Scale" (29-item version) at the annual evaluation. According to the duration of follow-up, patients were divided into a short-term (1,4 yr) and a long-term (5,18 yr) cohort. Medication non-compliance was measured using electronic monitoring. Results showed that increased hair growth was the most frequent symptom in both sexes. Symptom distress was more serious in women than in men. The most distressing symptom in women was excessive and/or painful periods, while in men this was impotence. Clear differences were revealed at item level between symptom occurrence and symptom distress in relationship with the two time cohorts and between sexes. No relationship was found between symptom experience and prednisolone non-compliance. [source] FC03.2 Cumulative incidence of self reported skin disease in hydrotherapists working in swimming poolsCONTACT DERMATITIS, Issue 3 2004Aneta Lazarov Objective:, To assess the cumulative incidence and characteristics of self reported skin disease in hydrotherapists. Methods:, Hydrotherapists, who had completed a hydrotherapy training course answered a questionnaire in reference to newly appeared skin disease. Data were analyzed statistically. Results:, 190 subjects presently working as hydrotherapists were studied. Of them 75.8% were female and 24.2% were male. 80% of the hydrotherapists worked up to 10 000 cumulative hours defined by the formula: working hours per weeks × number of weeks per year × years of work in the pool. 85 of the subjects (45%) reported on the development of skin disease for the first time after starting work at the swimming pool. 21 (11.8%) had a preexisting skin disease. The most frequent symptoms included pruritus, burning, stinging, erythematous patches and xerotic skin on the extremities, trunk and folds. A statistically significant relationship between the cumulative working time and the incidence of dermatological pathology compatible with contact dermatitis was found. Conclusions:, The incidence of self reported skin diseases, developing for the first time or due to exacerbation of preexisting dermatological conditions, in hydrotherapists working in swimming pools is high. Statistically significant relationship between the cumulative hours of immersion in the pool and the incidence of the dermatological pathology was observed suggesting a dose response relationship between exposure and effect. [source] Etiology and Distribution of Headaches in Two Brazilian Primary Care UnitsHEADACHE, Issue 3 2000Marcelo E. Bigal MD Objectives.,To determine (a) which patients seek primary care services with a complaint of headache, (b) the percentages of the various types of headache in this population, and (c) the impact of the care provided to these patients on the basic health care network. Background.,Headache is one of the most frequent symptoms reported in medical practice, resulting in significant medical services costs and loss of patient productivity, as well as reduced quality of life. Methods.,A prospective study was conducted in two towns (Ribeirão Preto and São Carlos) in the State of São Paulo, Brazil. The participants in the study consisted of 6006 patients (52.4% women) with highly varied acute symptoms. The patients ranged in age from 14 to 98 years. Results.,Headache as the main complaint was reported by 561 (9.3%) of the patients considered, with 312 (55.6%) of those patients presenting with primary headache, 221 (39.4%) with headaches secondary to systemic disorders, and 28 (5.0%) with headaches secondary to neurological disorders. Migraine, the most prevalent primary headache, accounted for 45.1% of patients reporting headache as the single symptom. The most frequent etiologies of headaches secondary to systemic disorders were fever, acute hypertension, and sinusitis. The most frequent headaches secondary to neurological disorders were posttraumatic headaches, headaches secondary to cervical disease, and expansive intracranial processes. Of the 26 cases of drug abuse, 20 were secondary to alcohol (hangover). Headaches secondary to systemic disorders were more frequent in the extreme age ranges. Conclusions.,Headache is a very frequent symptom among patients seen at primary health care units and should be considered a public health problem. The dissemination of the diagnostic criteria of the International Headache Society among primary health care physicians is urgently needed in order to avoid the repeated return of patients or their referral to more differentiated emergency units, which overburden an already insufficient health care network. [source] Stroke education: discrepancies among factors influencing prehospital delay and stroke knowledgeINTERNATIONAL JOURNAL OF STROKE, Issue 3 2010Yvonne Teuschl Background Time is essential for the treatment of acute stroke. Much time is lost outside the hospital, either due to failure in identifying stroke symptoms or due to a delay in notification or transport. We review studies reporting factors associated with better stroke knowledge and shorter time delays. We summarise the evidences for the effect of stroke knowledge and education on people's reaction in the acute situation of stroke. Methods We searched MEDLINE for studies reporting factors associated with prehospital time of stroke patients, or knowledge of stroke symptoms. Further, we searched for studies reporting educational interventions aimed at increasing stroke symptom knowledge in the population. Findings We included a total of 182 studies. Surprisingly, those factors associated with better stroke knowledge such as education and sociodemographic variables were not related to shorter time delays. Few studies report shorter time delays or better stroke knowledge in persons having suffered a previous stroke. Factors associated with shorter time delays were more severe stroke and symptoms regarded as serious, but not better knowledge about the most frequent symptoms such as hemiparesis or disorders of speech. Only 25,56% of patients recognised their own symptoms as stroke. While stroke education increases the knowledge of warning signs, a few population studies measured the impact of education on time delays; in such studies, time delays decreased after education. This may partly be mediated by better organisation of EMS and hospitals. Interpretation There is a discrepancy between theoretical stroke knowledge and the reaction in an acute situation. Help-seeking behaviour is more dependent on the perceived severity of symptoms than on symptom knowledge. Bystanders play an important role in the decision to call for help and should be included in stroke education. Education is effective and should be culturally adapted and presented in a social context. It is unclear which educational concept is best suited to enhance symptom recognition in the acute situation of stroke, especially in view of discrepancies between knowledge and action. [source] Teeth and blood lead levels in egyptian schoolchildren: relationship to health effectsJOURNAL OF APPLIED TOXICOLOGY, Issue 4 2001Magdy Omar Abstract The objective of this work was to study teeth and blood lead levels in Egyptian schoolchildren and to relate lead levels to sociodemographic and environmental factors, the degree of urbanization and suspected manifestations of possible lead exposure. The study was conducted on 60 children aged 6,12 years: 30 children living in an urban area at Alexandria City and 30 children living in a rural area at Kafr El-Sheikh Province. Both groups are matched for age and gender. Every child was subjected to history taking, clinical examination and IQ measurements. Laboratory investigations included measuring teeth and blood lead levels, haemoglobin, serum iron and total iron binding capacity. The results showed that the mean blood lead level of children in Alexandria was significantly higher than that of the children in Kafr El-Sheikh; also 56.7% and 6.7% of children from Alexandria and Kafr El-Sheikh had a blood lead level of >20 µg dl,1, with the most frequent symptoms of headache, arthralgia and lack of school interest. The children in Alexandria had significantly lower mean teeth lead and haemoglobin levels than those of the Kafr El-Sheikh group. A history of wrapping sandwiches in newspapers, age and distance between the home and school were significant predictors of lead exposure. These findings support the concept that teeth lead concentration may be a valid addition to the indicators used for assessment of the body burden of environmental lead. In addition, children living in urban areas such as Alexandria need special consideration regarding protection from lead exposure, as well as teeth and blood lead evaluation. Copyright © 2001 John Wiley & Sons, Ltd. [source] Enterovirus meningitis in Brazil, 1998,2003,JOURNAL OF MEDICAL VIROLOGY, Issue 1 2006Gina P.L. dos Santos Abstract Acute viral infections of the central nervous system (CNS) such as acute flaccid paralysis, meningitis, and encephalitis, are responsible for a high morbidity, particularly in children. Non-Polio enteroviruses (NPEV) are known to be responsible for over 80% of viral meningitis in which the etiologic agent is identified. In the present study, we show the frequency of enterovirus meningitis in Brazil from December 1998 to December 2003. Enterovirus were isolated from 162 (15.8%), of a total of 1,022 cerebrospinal fluid (CSF) specimens analyzed. Echovirus 30 was identified in 139 of these isolates (139/162,85.2%). Other identified enteroviruses were: Coxsackievirus B5 (3.7%), Echovirus 13 (3.7%), Echovirus 18 (3%), Echovirus 6 (1.2%), Echovirus 25 (1.2%), Echovirus 1 (0.6%), and Echovirus 4 (0.6%). Patients's age ranged from 28 days to 68 years old. The most frequent symptoms were fever (77%), headache (69.5%), vomiting (71.3%), neck stiffness (41.3%), convulsion (7.1%), and diarrhea (3.7%). Although, the majority of the patients recovered without any complication or permanent squeal, five deaths occurred. Throughout the surveillance period, five viral meningitis outbreaks were confirmed: four in the Southern Brazil and one in the Northeast Brazil. Echovirus 30 was responsible for four out of the five outbreaks while Echovirus 13 caused the fifth one. Besides the outbreaks, 734 sporadic cases were also identified during the study period and 59 of these were positive for virus isolation (8%). Echovirus 30 accounted for 70% of the isolates. Our results showed that Echovirus 30 was the most prevalent etiological agent of viral meningitis in Brazil, causing both outbreaks and sporadic cases. J. Med. Virol. 78:98,104, 2006. © 2005 Wiley-Liss, inc. [source] Varying clinical presentations at onset of type 1 diabetes mellitus in children , epidemiological evidence for different subtypes of the disease?PEDIATRIC DIABETES, Issue 4 2001Andreas Neu Abstract: Objective:, On the basis of 2121 case observations between 1987 and 1997, we describe the clinical and laboratory characteristics of diabetes mellitus type 1 at its onset. Our objective is to analyze whether clinical presentation follows a uniform pattern or whether there is evidence for different subtypes. Research design and methods: Thirty-one pediatric hospitals and one diabetes center in Baden-Wuerttemberg (BW), Germany, participated in this study. The hospital records of 2121 children below 15 yr of age were examined retrospectively. Statistical analysis was done after logarithmic transformation into a normal distribution. Results: The average duration of symptoms was found to be 15.2 d (95% CI (Confidence Intervals) = 14.3,16.1) ranging between 2.0 and 180 d (95% central range). The most frequent symptoms were polyuria and polydipsia; 7.2% presented with altered level of consciousness. The mean blood glucose value was 407.9 mg/dL (95% CI = 400.0,416.0), corresponding to 23.3 mmol/L (95% CI = 22.8,23.8). The median pH value was 7.35 (95% CI = 7.34,7.36), and the median base excess was ,5 mmol/L (95% CI =,5 to ,4). The younger patients had a shorter duration of symptoms and suffered most frequently from ketoacidosis. Conclusions: Although the symptoms of diabetes at its onset follow a uniform pattern, the clinical presentation and duration of symptoms indicate that there may be various forms of type 1 diabetes. [source] Reliability of a Rating Scale to Assess Post-stroke Psychiatric SymptomsPSYCHOGERIATRICS, Issue 1 2001Tadashi Kusunoki Background: Various rating scales for post-stroke psychiatric symptoms such as cognitive impairment have long been used in drug efficacy trials in Japan. However, their reliability has not been established. The purpose of the present study was to examine the inter-rater and intra-rater reliability of a rating scale, which has been conventionally used in Japan. Methods: The most frequent symptoms, including apathy, emotional and cognitive impairment, found in post-stroke patients were assessed using a rating scale comprising 17 items and 4 global assessment scales. Semi-structured interviews of 18 patients with symptoms with various degrees of severity were videotaped. Twelve physicians who were not interviewers independently assessed the severity of symptoms in the 18 patients by replaying the videotapes. This procedure was repeated twice with an interval of two months to examine inter-rater and test-retest reliability. Results: The results revealed almost satisfactory reliability. Intraclass correlation coefficients were over 0.6 in the inter-rater analysis for most items and the concordance correlation coefficients were over 0.7 in the intra-rater analysis. The rating scale was considered to be reliable, although some items showed relatively low agreement. Conclusion: The conventional rating scale to assess post-stroke psychiatric symptoms showed satisfactory inter-rater and intra-rater reliability by the videotape method. The validity study should be further investigated. [source] Ectopic calcification among families in the Azores: Clinical and radiologic manifestations in families with diffuse idiopathic skeletal hyperostosis and chondrocalcinosisARTHRITIS & RHEUMATISM, Issue 4 2006Jácome Bruges-Armas Objective Twelve families that were multiply affected with diffuse idiopathic skeletal hyperostosis (DISH) and/or chondrocalcinosis, were identified on the island of Terceira, The Azores, potentially supporting the hypothesis that the 2 disorders share common etiopathogenic factors. The present study was undertaken to investigate this hypothesis. Methods One hundred three individuals from 12 unrelated families were assessed. Probands were identified from patients attending the Rheumatic Diseases Clinic, Hospital de Santo Espírito, in The Azores. Family members were assessed by rheumatologists and radiologists. Radiographs of all family members were obtained, including radiographs of the dorsolumbar spine, pelvis, knees, elbows, and wrists, and all cases were screened for known features of chondrocalcinosis. Results Ectopic calcifications were identified in 70 patients. The most frequent symptoms or findings were as follows: axial pain, elbow, knee and metacarpophalangeal (MCP) joint pain, swelling, and/or deformity, and radiographic enthesopathic changes. Elbow and MCP joint periarticular calcifications were observed in 35 and 5 patients, respectively, and chondrocalcinosis was identified in 12 patients. Fifteen patients had sacroiliac disease (ankylosis or sclerosis) on computed tomography scans. Fifty-two patients could be classified as having definite (17%), probable (26%), or possible (31%) DISH. Concomitant DISH and chondrocalcinosis was diagnosed in 12 patients. Pyrophosphate crystals were identified from knee effusions in 13 patients. The pattern of disease transmission was compatible with an autosomal-dominant monogenic disease. The mean age at which symptoms developed was 38 years. Conclusion These families may represent a familial type of pyrophosphate arthropathy with a phenotype that includes peripheral and axial enthesopathic calcifications. The concurrence of DISH and chondrocalcinosis suggests a shared pathogenic mechanism in the 2 conditions. [source] Prevalence of urinary incontinence in women with cystic fibrosisBJU INTERNATIONAL, Issue 1 2001M. Cornacchia Objective To determine the prevalence of urinary incontinence (UI) in female patients (aged 15 years) attending a cystic fibrosis (CF) centre, in whom stress UI could be common, as chronic coughing and sputum production are frequent symptoms associated with progressive lung disease in these patients. Patients and methods An anonymous questionnaire was completed by 176 women with CF (mean age 24.6 years, sd 5.8) during routine assessments as outpatients. Results In all, 72 patients (41%) were classified as never incontinent; occasional UI was reported in 61 women (35%). Regular UI, occurring twice or more a month for at least two consecutive months in the last year, was reported in 43 patients (24%). Regular UI was associated with increasing age and a lower mean (sd) forced expiratory volume/s (of that predicted) than in women with no urinary symptoms, at 26.9 (6.5) years and 53.5 (23.5)%, and 23.1 (5.4) years and 65.5 (23.2)%, respectively (P < 0.01 and P < 0.05, respectively). All incontinent women recorded stress UI; coughing, laughing and physical activity were associated with UI in 92%, 33% and 21% of the patients, respectively. Conclusion Stress UI is a common symptom in women with CF. As urine loss can be under-reported to the healthcare providers, women should be asked about incontinence as part of their routine follow-up. Pelvic floor muscle exercises are effective in treating stress UI and should be considered for those with CF and regular UI. [source] Patient-reported acute gastrointestinal symptoms during concurrent chemoradiation treatment for rectal cancer,CANCER, Issue 8 2010Ronald C. Chen MD Abstract BACKGROUND: Although it is known that standard 5-fluorouracil,based chemoradiation therapy for rectal cancer causes significant acute gastrointestinal (GI) toxicity, research on patient-reported outcomes (PROs) is limited. The authors undertook the current study to assess the feasibility of incorporating PRO measurement into routine clinical practice and to describe the trajectory of symptom development during treatment. METHODS: Seventy-seven consecutive patients who were treated between 2006 and 2008 were eligible. Patients completed the 7-item Bowel Problems Scale immediately before weekly physician visits. RESULTS: The questionnaire completion rate was 95%. Individual GI symptoms had different trajectories of development. By Week 5, approximately 40% of all patients developed clinically meaningful pain, bowel urgency, or tenesmus that was not present during Week 1; 30% developed diarrhea, abdominal cramping, and passing mucus. However, overall symptom burden was moderate. Seventy-five percent of patients who presented with rectal bleeding at Week 1 improved by Week 3 of treatment. Within each physician-assessed grade of diarrhea, patient experience varied widely. For example, of the 50 patients who developed grade 2 diarrhea on the Radiation Therapy Oncology Group Acute Morbidity Scale, the numbers of patients reporting only occasional symptoms versus those reporting frequent or very frequent symptoms were similar. CONCLUSIONS: PROs provided information on patient symptoms during chemoradiation treatment for rectal cancer that was not captured otherwise, and it was feasible to incorporate PROs into routine clinical practice. The current results may be used by physicians to counsel their patients before treatment initiation and to provide a benchmark against which trials that use new therapies may be compared. Cancer 2010; 116:1879,86. © 2010 American Cancer Society. [source] 1255: Diagnosis of retinoblastomaACTA OPHTHALMOLOGICA, Issue 2010L DESJARDINS Purpose Retinoblastoma is the most frequent malignant intra ocular tumors in childhood. The incidence is one out of 15000 to 18000 births. The median age at diagnosis is 24 months for unilateral and 12 months for bilateral. The genetic predisposition is autosomal do Methods In 1971 Knudson made the hypothesis that 2 genetic alterations in the same retinal cell were necessary. In bilateral disease there is one germline and one somatic mutation and in unilateral non hereditary, 2 somatic mutations. The Rb1gene is located on chromosome 13 q 1-4 . The Rb 1 protein is a pocket protein involved in the cell cycle regulation Results Most frequent symptoms are leukocoria and strabismus Later symptoms include heterochromia iridis,rubeosis, buphtalmia, pseudo hypopion, uveitis, inflammatory pseudo tumor and exophtalmia. Diagnosis of retinoblastoma is made by fundus examination. Imaging of the orbits and brain should be performed using MRI if possible. Ultrasonography with B and A scan is also useful as well as the use of Retcam . Differential diagnosis is sometimes easy when there is colobomas ,persistance of hyperplastic primary vitreous ,hamartomas or astrocytomas It can be difficult in cases of advanced Coats disease or when there is diffuse infiltrating retinoblastoma. Conclusion We have made a retrospective study on patients sent for suspicion of retinoblastoma in our institute from January 2003 to December 2005 If we compare this serie to the serie published in the literature we can say that the pourcentage of well diagnosed retinoblastoma is improving. We have found 16% of wrong diagnostics. There was 30% in the serie of Balmer in 1988 and 42% in the serie of Shields in 1991. The most frequent differential diagnosis reported in all series is Coats disease [source] Clinical presentation of leptospirosis: a retrospective study of 34 patients admitted to a single institution in metropolitan FranceCLINICAL MICROBIOLOGY AND INFECTION, Issue 5 2005S. Jauréguiberry Abstract Leptospirosis has a highly variable clinical presentation, which may be related to different infecting serovars, host factors, or a combination of these. This study investigated retrospectively 34 consecutive patients with serologically confirmed leptospirosis admitted during the period 1992,2002. On admission, the most frequent symptoms were fever (100%), headache (75%), myalgia (55%), arthralgia (45%) and vomiting (39%). Pertinent laboratory findings included lymphopenia (85%), thrombocytopenia (75%), elevated liver enzymes (87%) and renal abnormalities (proteinuria, 77%; haematuria, 58%; elevated serum creatinine, 53%). The study confirmed the variable clinical and biological symptoms of leptospirosis, and indicated that lymphopenia is a common feature of leptospirosis cases. [source] | |||||||||||||