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Illustrative Case (illustrative + case)
Terms modified by Illustrative Case Selected AbstractsSignificance of autofluorescence in choriocapillaritisACTA OPHTHALMOLOGICA, Issue 2009A MANTOVANI Purpose To investigate the autofluorescence findings associated with choriocapillaritis Methods Illustrative cases of Primary Inflammatory Choriocapillaropathies(PICCPs)including Multiple Evanescent White Dot Syndrome (MEWDS), Acute Placoid Multifocal Pigment Epitheliopathy (APMPPE) or Multifocal Choroiditis (MFC), where Fundus Autofluorescence(FAF) images were obtained in the short wave mode(488nm), lipofuscin-related, or in near-infrared mode(787), melanin-related. Results In the groups of MEWDS and MFC patients, the more striking FAF alteration is an increase in autofluorescence. The areas of FAF do not strictly correspond to areas of ICGA hypofluorescence, with less FAF in areas of more pronounced ICGA hypofluorescence. The areas of increased FAF regress almost totally in the convalescent stage. In the APMPPE group, the placoid lesions are very often hypoautofluorescent except the margins that can be hyperautofluorescent. In the convalescent stage, altered FAF regresses, but bright FAF is often seen in the center of chorioretinal scars, corresponding to accumulation of fluorophores debris. Conclusion FAF is a complementary imaging technique in PICCPs indicating RPE cell dysfunction, but the information we have so far is scarce and has to be elucidated. In less severely hypoperfused areas,such as MEWDS and MFC, FAF488 is increased because the metabolism of the RPE cell is affected, which explains the accumulation of lipofuscin in its lysosomes. In conditions with severely nonperfused areas, such as APMPPE, FAF488 is very often decreased because RPE cell metabolism is probably affected to such a degree that it does not ingest any more lipofuscin and does not cause autofluorescence. [source] Gain in accuracy for diagnosis and follow-up of uveitis through indocyanine green angiographyACTA OPHTHALMOLOGICA, Issue 2009CP HERBORT Purpose The proportion of diseases involving principally the choroid is as frequent if not more frequent than those involving the superficial structures of the fundus and are therefore not accessible or poorly accessible to fluorescein angiography (FA) nor OCT. Methods Illustrative cases where the preponderant lesions are in the choroid are presented showing that the detection and follow-up of choroiditis is only meaningful using indocyanine green angiography (ICGA). Results Diseases that do not involve the choroid are the minority. Except for intermediate uveitis, mainly of the pars planitis type, and Behçet's uveitis, choroidal involvement cannot be excluded. Therefore in most other uveitis cases with suspected posterior involvement, if angiographic investigation is felt necessary, the initial angiography should always be a dual FA/ICGA angiography even if the predominant fundus sign is retinal vasculitis. Only if the initial angiography does not show choroidal involvement can the follow-up be preformed by FA alone. Conclusion In order to perform adequate diagnosis, adequate assessement of lesions and adequate follow-up in uveitis cases with choroidal involvement ICGA is mandatory. [source] Optimised monitoring of inflammation suppressive therapy (IST) in uveitisACTA OPHTHALMOLOGICA, Issue 2009CP HERBORT Purpose The array of inflammation suppressive therapies (IST) has increased trumendously in the last two decades including the availability of biological molecules with potent immunomodulatary activities as well as new immunosuppressive agents. In parallel measuring methods for intraocular inflammation have become available allowing much more acurate monitoring of the evolution of inflammation and its response to therapy. In addition to the traditionally used fluorescein angiography (FA), laser flare photometrry (LFP), indocyanine green angiography ICGA) and optical coherence tomography (OCT) are among the new investigational methods that have become available, each of them allowing us to establish inflammatory activity with increased precision and to explore compartments previously poorly accessible. Methods The advantages of each method will be put forward. Illustrative cases will be taken as examples to show the degree of precision obtained by combining the different methods presently at our disposal for the follow-up and monitoring of inflammation suppressive treatment. Results These cases will show that the presently available tools for optimal monitoring of intraocular inflammation allow the clinician to be better aware of the level of inflammatory activity and to better adapt his treatment. Conclusion Not only he availability of potent new therapies but also the possibility to follow more precisely intraocular inflammation with new precise devices has certainly changed the outcome of uveitis cases in recent years. [source] A Simple Method of Designing a Bilobed Flap Using a Triangle TemplateDERMATOLOGIC SURGERY, Issue 10 2004Li-Xing Man MSc Background. The bilobed flap is useful for the reconstruction of skin defects in which the primary closure is difficult. Proper design is paramount to achieve excellent cosmetic results, but flap design often appears unnecessarily complex and difficult. Objective. The objective was to discuss the geometry of the bilobed flap and describe a simple and practical method for constructing such flaps using a triangle template with emphasis on the pivot point. Methods. A detailed description with diagrams and an illustrative case are presented to demonstrate the technique. Results. A patient with a scalp defect was reconstructed with a triangle-template-designed bilobed flap with excellent postoperative results. Conclusion. This new method using a triangle template ensures proper placement of the pivot point and will enable practitioners to achieve superior outcomes. [source] Anabolic,androgenic steroid dependence: an emerging disorderADDICTION, Issue 12 2009Gen Kanayama ABSTRACT Aims Anabolic,androgenic steroids (AAS) are widely used illicitly to gain muscle and lose body fat. Here we review the accumulating human and animal evidence showing that AAS may cause a distinct dependence syndrome, often associated with adverse psychiatric and medical effects. Method We present an illustrative case of AAS dependence, followed by a summary of the human and animal literature on this topic, based on publications known to us or obtained by searching the PubMed database. Results About 30% of AAS users appear to develop a dependence syndrome, characterized by chronic AAS use despite adverse effects on physical, psychosocial or occupational functioning. AAS dependence shares many features with classical drug dependence. For example, hamsters will self-administer AAS, even to the point of death, and both humans and animals exhibit a well-documented AAS withdrawal syndrome, mediated by neuroendocrine and cortical neurotransmitter systems. AAS dependence may particularly involve opioidergic mechanisms. However, AAS differ from classical drugs in that they produce little immediate reward of acute intoxication, but instead a delayed effect of muscle gains. Thus standard diagnostic criteria for substance dependence, usually crafted for acutely intoxicating drugs, must be adapted slightly for cumulatively acting drugs such as AAS. Conclusions AAS dependence is a valid diagnostic entity, and probably a growing public health problem. AAS dependence may share brain mechanisms with other forms of substance dependence, especially opioid dependence. Future studies are needed to characterize AAS dependence more clearly, identify risk factors for this syndrome and develop treatment strategies. [source] The Acidity of Brønsted CH Acids in DMSO , The Extreme Acidity of NonacyanocyclononatetraeneEUROPEAN JOURNAL OF ORGANIC CHEMISTRY, Issue 24 2004Robert Vianello Abstract The gas-phase (GP) acidity of a large variety of CH organic acids is studied by a carefully selected B3LYP/6-311+G(2d,p)//B3LYP/6-31G(d) theoretical model. Acidities are mirrored by the proton affinities of the corresponding conjugate bases. A very good agreement with available experimental data is achieved. It is concluded that the model applied has a high predictive value and that theoretical PA(anion)GP values can be used instead of measured data in cases where experiments are not feasible or not performed. It is shown, employing the isodensity polarized continuum model (IPCM), that there is a good linear relationship between the enthalpies of the proton-transfer reactions in DMSO and the observed pKa(DMSO) values. This relation can be used in predicting the acidity of strong, neutral organic superacids. As an illustrative case, the acidity of cyclononatetraene-1,2,3,4,5,6,7,8,9-nonacarbonitrile ("nonacyanocyclononatetraene") is considered. It is conclusively shown that this compound should be a very potent superacid, as evidenced by its PA(anion)GP (260.0 kcal·mol,1) and pKa (,14.8). The origin of high acidity is identified as a very strong anionic resonance effect in the resulting conjugate base. (© Wiley-VCH Verlag GmbH & Co. KGaA, 69451 Weinheim, Germany, 2004) [source] A backoff strategy for model-based experiment design under parametric uncertaintyAICHE JOURNAL, Issue 8 2010Federico Galvanin Abstract Model-based experiment design techniques are an effective tool for the rapid development and assessment of dynamic deterministic models, yielding the most informative process data to be used for the estimation of the process model parameters. A particular advantage of the model-based approach is that it permits the definition of a set of constraints on the experiment design variables and on the predicted responses. However, uncertainty in the model parameters can lead the constrained design procedure to predict experiments that turn out to be, in practice, suboptimal, thus decreasing the effectiveness of the experiment design session. Additionally, in the presence of parametric mismatch, the feasibility constraints may well turn out to be violated when that optimally designed experiment is performed, leading in the best case to less informative data sets or, in the worst case, to an infeasible or unsafe experiment. In this article, a general methodology is proposed to formulate and solve the experiment design problem by explicitly taking into account the presence of parametric uncertainty, so as to ensure both feasibility and optimality of the planned experiment. A prediction of the system responses for the given parameter distribution is used to evaluate and update suitable backoffs from the nominal constraints, which are used in the design session to keep the system within a feasible region with specified probability. This approach is particularly useful when designing optimal experiments starting from limited preliminary knowledge of the parameter set, with great improvement in terms of design efficiency and flexibility of the overall iterative model development scheme. The effectiveness of the proposed methodology is demonstrated and discussed by simulation through two illustrative case studies concerning the parameter identification of physiological models related to diabetes and cancer care. © 2009 American Institute of Chemical Engineers AIChE J, 2010 [source] A peritoneal dialysis patient with fatal culture-negative peritonitisNEPHROLOGY, Issue 1 2003Case Discussion SUMMARY: Culture-negative peritoneal inflammation accounts for between 5 and 20% of cases of peritonitis in peritoneal dialysis patients. Diagnostic yields may be enhanced considerably by reculturing dialysate effluents using appropriate collection methods and optimal laboratory techniques (including prolonged low-temperature and anaerobic incubations). In patients with persistent culture-negative peritonitis, consideration should be given to the possibilities of unusual or fastidious microorganisms (especially fungi and mycobacteria) and non-infective causes (especially drug reactions, malignancy, visceral inflammation and retroperitoneal inflammation). In this paper, an illustrative case of persistent culture-negative peritonitis is presented followed by a discussion of the investigative approach to such patients, with particular emphasis on differential diagnosis and the limitations of currently available tests. [source] The Brain First or the Heart: The Approach to Revascularizing Severe Co-Existing Carotid and Coronary Artery DiseaseCLINICAL CARDIOLOGY, Issue 8 2009Raed Aqel MD Combined symptomatic severe cerebralvascular disease and significant obstructive coronary artery disease frequently exist.1,2 For the past few decades, clinicians have debated the various treatment strategies for these high-risk patients including staged procedures and hybrid revascularization. While some recommend addressing the more unstable vascular territory first, others prefer to intervene on the carotids prior to performing coronary revascularization. Both surgical and percutaneous options have been explored in various clinical settings, but there are no treatment guidelines to date. Given the frequency and magnitude of this problem, we performed an extensive review of the literature in an attempt to add some much needed clarity. An illustrative case and recommendations are provided. Copyright © 2009 Wiley Periodicals, Inc. [source] Regional Pericarditis: A Review of the Pericardial Manifestations of Acute Myocardial InfarctionCLINICAL CARDIOLOGY, Issue 3 2009Todd A. Dorfman MD Abstract Regional pericarditis has been described in several settings, but occurs most frequently after transmural myocardial infarction. While the diagnosis remains elusive, it must be considered in all patients with recurrent chest pain following acute myocardial infarction (AMI). Pericarditis classically presents with positional chest pain, a pericardial friction rub, diffuse ST-segment elevation, and PR depression, but regional ECG changes associated with infarction-associated pericarditis sometimes exist. Given the magnitude and frequency of AMI, it is imperative to be aware of the myriad of pericardial manifestations of myocardial injury. An illustrative case and a comprehensive review of the literature will be provided. Copyright © 2009 Wiley Periodicals, Inc. [source] An Unusual Manifestation of Tako-tsubo CardiomyopathyCLINICAL CARDIOLOGY, Issue 5 2008Todd A. Dorfman M.D. Abstract Takotsubo cardiomyopathy typically presents with chest pain, ST changes, and transient left ventricular apical ballooning in the absence of epicardial coronary artery disease. This process is reversible and usually benign. An unusual manifestation is that of left ventricular outflow tract obstruction with systolic anterior motion of the mitral valve. Recognition of this finding is critical in patient management especially in the setting of cardiogenic shock, as inotropes are likely to aggravate and worsen the clinical condition. We provide a systematic review and an illustrative case and discuss treatment strategies. Copyright © 2007 Wiley Periodicals, Inc. [source] Noncompaction of the Ventricular Myocardium: Report of Two Cases With Bicuspid Aortic Valve Demonstrating Poor Prognosis and With Prominent Right Ventricular InvolvementECHOCARDIOGRAPHY, Issue 4 2003Yuksel Cavusoglu Noncompaction of the ventricular myocardium is a rare, unclassified cardiomyopathy due to an arrest of myocardial morphogenesis. The characteristic echocardiographic findings consist of multiple, prominent myocardial trabeculations and deep intertrabecular spaces communicating with the left ventricular (LV) cavity. The disease typically involves the LV myocardium, but right ventricular (RV) involvement is not uncommon. The clinical manifestations include heart failure (HF) signs, ventricular arrhythmias and cardioembolic events. Noncompacted myocardium may occur as an isolated cardiac lesion, as well as it can be in association with congenital anomalies. We describe two illustrative cases of noncompaction of the ventricular myocardium, a 19-year-old male with bicuspid aortic valve and progressive worsening of HF, and a 61-year-old male with marked RV involvement in addition to LV apical involvement, both with the typical clinical and echocardiographic features of the disease. (ECHOCARDIOGRAPHY, Volume 20, May 2003) [source] International Nonregimes: A Research Agenda,INTERNATIONAL STUDIES REVIEW, Issue 2 2007Radoslav S. Dimitrov Why are multilateral institutions absent from some areas of international relations? Governments have not concluded regulatory policy agreements on tactical nuclear weapons and small arms control, deforestation, information privacy, and other transnational issues. The absence of regimes in such policy arenas is an empirical phenomenon with considerable theoretical and policy implications. Yet, existing scholarship on global governance largely ignores the instances in which such institutions do not emerge. This essay develops a research agenda to extend and strengthen regime theory through analysis of nonregimes. We articulate the concept, draw a typology of nonregimes, discuss the contributions that nonregime studies can make to IR theory, outline methodological approaches to pursue the proposed agenda, and highlight a priori theoretical considerations to guide such research. Six illustrative cases in the realms of arms control, environmental management, and international political economy are described and used to make preliminary observations of factors that impede regime formation. [source] Review of non-positron emission tomography functional imaging of primary musculoskeletal tumours: Beyond the humble bone scanJOURNAL OF MEDICAL IMAGING AND RADIATION ONCOLOGY, Issue 6 2005YY Ho Summary Bone and soft tissue tumours are rare neoplasms. There are five major roles of imaging in the management of primary musculoskeletal tumours, that is, to differentiate between benignity and malignancy, to evaluate for local tumour extension, to screen for metastases, to judge the effect of chemotherapy, and to monitor for recurrence. To accomplish this, multiple modalities are required because no single examination is able to complete all these tasks. These modalities include plain radiography, CT, MRI, conventional nuclear medicine as well as positron emission tomography (PET) imaging. Elsewhere, PET imaging has been discussed at length, because it is likely to be superior in the assessment of bone and soft tissue tumours over conventional nuclear medicine procedures. However, conventional nuclear medicine may be of value when PET is unavailable. In this review, an overview of anatomical imaging will be given and the role of non-PET functional imaging will be discussed in detail. A variety of illustrative cases will be presented. [source] Bootstrap Methods in Econometrics*THE ECONOMIC RECORD, Issue 2006JAMES G. MacKINNON There are many bootstrap methods that can be used for econometric analysis. In certain circumstances, such as regression models with independent and identically distributed error terms, appropriately chosen bootstrap methods generally work very well. However, there are many other cases, such as regression models with dependent errors, in which bootstrap methods do not always work well. This paper discusses a large number of bootstrap methods that can be useful in econometrics. Applications to hypothesis testing are emphasized, and simulation results are presented for a few illustrative cases. [source] The Value of Enhanced Magnetic Resonance Imaging in the Evaluation of Endocochlear Disease,THE LARYNGOSCOPE, Issue 1 2002Joseph L. Hegarty MD Abstract Background Gadolinium-enhanced magnetic resonance imaging (GdMRI) is routinely used in the evaluation and management of suspected retrocochlear pathology such as vestibular schwannoma. However, its value in the evaluation and diagnosis of cochlear pathology associated with sensorineural hearing loss (SNHL) has been less clear. Study Design Retrospective review of case histories and imaging studies of patients with SNHL and cochlear enhancement on GdMRI diagnosed between 1998 and 2000. Results Five patients with SNHL who required gadolinium administration to establish the diagnosis of endocochlear disease were identified. Diagnosed lesions included an intralabyrinthine schwannoma, intracochlear hemorrhage, radiation-induced ischemic change, autoimmune labyrinthitis, and meningogenic labyrinthitis. In these illustrative cases, the GdMRI demonstrated intrinsic high signal or contrast enhancement within the cochlea and labyrinth in the absence of a retrocochlear mass. In one patient with meningogenic labyrinthitis, cochlear enhancement on MRI led to prompt cochlear implantation before the potential development of cochlear ossification. Conclusion Our experience suggests that GdMRI plays a crucial role in the diagnosis of cochlear pathology associated with sensorineural hearing loss and may directly impact patient management. [source] A Review of the Federal Guidelines That Inform and Influence Relationships Between Physicians and IndustryACADEMIC EMERGENCY MEDICINE, Issue 8 2009Robert H. Birkhahn MD Abstract The effective delivery and continued advancement of health care is critically dependent on the relationship between physicians and industry. The private sector accounts for 60% of the funding for clinical research and more than 50% of the funding sources for physician education. The nature of the physician,industry relationship and the role of the physician as a gatekeeper for health care make this association vulnerable to abuse if certain safeguards are not observed. This article will review the current federal guidelines that affect the physician,industry relationship and highlight several illustrative cases to show how the potential for abuse can subvert this relationship. The recommendations and "safe harbors" that have been designed to guide business relationships in health care are discussed. [source] | |||||||||||||