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Selected AbstractsTrigeminal Trophic Syndrome,Report of Four Cases and Review of the LiteratureDERMATOLOGIC SURGERY, Issue 5 2004Parrish Sadeghi MD Background. Trigeminal trophic syndrome is a unilateral, frequently crescent-shaped neurotrophic ulceration of the face occurring after injury to the trigeminal nerve. The appearance of the ulcers resembles other disease entities such as granulomatous disease, neoplasm, vasculitis, infection, and factitial dermatitis. Objectives. The objectives of this study are to increase awareness of this disorder and to emphasize the importance of eliciting a thorough neurologic history when evaluating facial ulcerations. Methods. Four cases are reported and, using MEDLINE, the English and non-English literature from 1982 to 2002 is reviewed. Results. Including this report, there have been 60 cases of trigeminal trophic syndrome reported from 1982 to 2002. The age at presentation ranged from 14 months to 93 years. Time of onset from injury to the trigeminal ganglion or its branches and the development of the ulcers ranged from 2 weeks to 30 years. One-third of the patients had undergone trigeminal nerve ablation for the treatment of trigeminal neuralgia and another third had a history of stroke. Other causes included craniotomy, head trauma, herpes infection. Conclusion. The majority of cases of trigeminal trophic syndrome are associated with a history of stroke or trigeminal nerve ablation. Successful surgical outcome can be achieved if the underlying neurologic pathology is addressed before the reconstructive procedure. [source] Male drugs-related deaths in the fortnight after release from prison: Scotland, 1996,99ADDICTION, Issue 2 2003Sheila M. Bird ABSTRACT Aims, To assess if 15,35-year-old males released after 14 + days' imprisonment in Scotland, 1996,99, had a higher drugs-related death rate in 2 weeks after release than during subsequent 10 weeks; higher than expected death rate from other causes; and if drugs-related deaths in the first fortnight were three times as many as prison suicides. Design, Confidential linkage of ex-prisoner database against deaths. Setting, Scotland's male prisons and young offenders' institutions during July to December 1996,99; 19 486 index releases after 14+ days' incarceration. Measurements, Relative risk of drugs-related death in the first 2 weeks after release (34 deaths) versus subsequent 10 weeks (23). Other causes of death (21) relative to expectation. Drugs-related deaths in first 2 weeks after release relative to suicides in prison (12). Findings, Drugs-related mortality in 1996,99 was seven times higher (95% CI: 3.3,16.3) in the 2 weeks after release than at other times at liberty and 2.8 times higher than prison suicides (95% CI: 1.5,3.5) by males aged 15,35 years who had been incarcerated for 14+ days. We estimated one drugs-related death in the 2 weeks after release per 200 adult male injectors released from 14 + days' incarceration. Non-drugs-related deaths in the 12 weeks after release were 4.9 times (95% CI: 2.8,7.0) the 4.3 deaths expected. Conclusion, Investment in, and evaluation of, prison-based interventions is needed to reduce substantially recently released drugs-related deaths. [source] A fatal case of enoxaparin induced skin necrosis and thrombophiliaEUROPEAN JOURNAL OF HAEMATOLOGY, Issue 2 2006Yona Nadir Abstract:, Skin necrosis caused by heparins is a rare complication. We report a case of a 71-yr-old white woman who developed painful diffuse skin lesions, most probably related to enoxaparin treatment. Other causes of skin necrosis, including heparin induced thrombocytopenia, disseminated intravascular coagulation, protein C/protein S deficiencies, anti-phospholipid antibodies, and vitamin K deficiency were less likely in this case. The concomitant combined thrombophilia possibly aggravated the patient's clinical presentation. [source] Neurobrucellosis as an exceptional cause of transient ischemic attacksEUROPEAN JOURNAL OF NEUROLOGY, Issue 5 2006A. Bingöl We report a series of four cases presented with transient ischemic attacks (TIA) or ischemic stroke as the predominant manifestation of neurobrucellosis (NB). Three of the patients were 20,28 years of age, and one patient was 53 years old. They all used to consume unpasteurized milk or its products. Two patients had systemic brucellosis in the past and received antibiotic treatment. Other causes of TIA including cardiac embolism, hypercoagulability, vascular malformations, systemic vasculitis, and infective endocarditis were excluded. NB was diagnosed with serological tests or cultures for Brucella in the cerebrospinal fluid. None of the patients had any further TIA after the initiation of specific treatment. NB should always be sought in young patients with TIA or ischemic stroke, especially if they have no risk factors for stroke and live in an endemic area for brucellosis, even if they do not have other systemic signs of brucellosis. [source] Acute hepatitis C in HIV-infected men who have sex with menHIV MEDICINE, Issue 4 2004J Ghosn Background Hepatitis C virus (HCV) is usually transmitted via the parenteral route, but there are widely discrepant findings on its possible sexual transmission. Thus there are no recommendations concerning protected sex for couples in which only one partner is HCV-infected. Whether HIV or other sexually transmitted diseases could favour HCV transmission remains unclear, but recent data suggesting an increasing incidence of acute HCV in HIV-infected men underline the major public health implications of this issue. Case reports Between June 2002 and July 2003, five HIV-infected homosexually active men presented with primary (n=4) and secondary (n=1) syphilis and concomitant abnormal liver function tests revealing acute asymptomatic HCV seroconversion. Other causes of acute viral hepatitis were inquired into and excluded. Highly at-risk sexual behaviour, including unprotected anal intercourse and unsafe oral sex, with concomitant syphilis, was found to be the only identifiable important risk factor for transmission of HCV. Conclusions Sexual transmission may be fuelling a significant increase in HCV seroconversions among HIV-infected men who have highly risky sexual behaviours. Given the recent data suggesting the spread of sexually transmitted infections among HIV-infected gay men, specific recommendations concerning safe sex are urgently needed. [source] Transcatheter Closure of Patent Foramen Ovale in Patients with Paradoxical Embolism.JOURNAL OF INTERVENTIONAL CARDIOLOGY, Issue 2 2008Follow-up Results after Implantation of the Starflex® Occluder Device with Conjunctive Intensified Anticoagulation Regimen, Procedural Background:Prevalence of patent foramen ovale (PFO) is higher in patients with paradoxical embolism and associated with increased risk for recurrent thromboembolic events. By percutaneous closure of PFO, surgical closure or permanent oral anticoagulation can be avoided. So far, published series included different occluder systems and various indications and regimens of postprocedural anticoagulation. The aim of the present study was to evaluate the short- and long-term results after implantation of the Starflex® occluder in patients with PFO using an intensified anticoagulation regimen. Methods and Results:154 patients with PFO (94 men; age: 44 ± 13 years) and >1 thromboembolic event were included. Other causes for embolism were excluded. PFO closure was successful in 147 patients (95.5%). All patients were treated with phenprocoumon (INR 2.5) and aspirin (100 mg/die) for 6 months. Transesophageal echocardiography (TEE) was repeated at 6 months. Mean clinical follow-up period was 26 ± 18 months. After 6 months, five patients had a significant residual shunt, and five patients had suspected thrombus formation on the occluder. In three of these five patients, the occluder was surgically removed and foreign body reaction was noted. During follow-up, nine patients suffered from neurological events (two strokes, seven transient ischemic attacks [TIA]), though complete closure of the PFO was documented by TEE. Two patients died during follow-up; three patients had bleeding complications. Conclusion:Percutaneous closure of PFO in symptomatic patients by Starflex® occluder represents an effective therapy with a low incidence of periinterventional complications and recurrent thromboembolism. However, thrombus formation at the occluder system may occur in some patients despite an aggressive anticoagulation regimen. [source] Case reports: tinea corporis in a 13-year-old German girl due to Trichophyton schoenleiniiMYCOSES, Issue 11-12 2004T. C. Roos Trichophyton schoenleinii; Tinea corporis Summary We report the first case of a tinea corporis with partly profound lesions in a 13-year-old girl on her arms, legs and trunk due to Trichophyton schoenleinii but without any lesion on scalp and hair. Moreover, this is the first case of an infection with Trichophyton schoenleinii in Germany since more than 40 years. The diagnosis was confirmed by microscopy of mycological specimens. Other causes of the skin symptoms could be excluded (atopic dermatitis, bacterial or other fungal infection). Clinical and epidemiological aspects of this anthropophile dermatophyte are briefly reviewed. Zusammenfassung Wir berichten über den ersten Fall einer Tinea corporis mit teilweise profunden Läsionen bei einem 13jährigen Mädchen an Armen, Beinen und am Stamm verursacht durch Trichophyton schoenleinii. Darüber hinaus ist dies der erste in Deutschland aufgetretene Fall einer Trichophyton schoenleinii Infektion seit über 40 Jahren. Außerdem war es sehr ungewöhnlich, dass die Patientin keine Symptome einer Tinea capitis bzw. eines Haarbefalls, eines Favus oder eines Pseudomyzetoms zeigte, sondern ausschließlich nummuläre, tief excoriierte Läsionen einer Tinea corporis. Die Diagnose wurde kulturell bestimmt. Klinik und Epidemiologie dieses anthropophilen Dermatophyten werden diskutiert. [source] Pulmonary hemorrhage/hemoptysis in childrenPEDIATRIC PULMONOLOGY, Issue 6 2004Simon Godfrey MD Abstract Pulmonary hemorrhage and hemoptysis are uncommon in childhood, and the frequency with which they are encountered by the pediatric pulmonologist depends largely on the special interests of the center to which the child is referred. In those centers caring for children with cystic fibrosis or congenital heart disease, these will be by far the most common causes of hemoptysis. Other causes of hemoptysis are far less common, such as bleeding from localized lesions in the upper airway or tracheobronchial tree. Even less common is bleeding into the lungs as part of a systemic disease, usually with renal involvement (pulmonary-renal syndromes), such as systemic lupus erythematosis or Goodpasture's syndrome. Bleeding into the lungs in children with a bleeding diathesis probably only occurs in immunosuppressed children after transplantation. When no other cause is found for pulmonary hemorrhage, the presumed diagnosis is idiopathic pulmonary hemosiderosis. This review discusses the various causes of hemoptysis and pulmonary hemorrhage, and the appropriate investigations to aid in determining the correct diagnosis. The management and prognosis of idiopathic pulmonary hemosiderosis, based on cumulative experience from published reports, are considered in more detail. Pediatr Pulmonol. 2004; 37:476,484. © 2004 Wiley-Liss, Inc. [source] Incidence of giardiasis among siblings in TurkeyPEDIATRICS INTERNATIONAL, Issue 3 2003I. Cüneyt Balcioglu AbstractBackground:,Giardiasis, a common infection among children, is caused by a flagellated protozoan called Giardia lamblia. It is well known to be contagious in common living places. This is an epidemiologic study investigating the incidence of giardiasis among the siblings of patients with giardiasis living in the same household. Methods:,Stool samples of 50 patients with a G. lamblia positive sibling in the same household, and 50 patients with a G. lamblia negative sibling in the same household, were examined for giardiasis by saline-Lugol, formalin-ethyl acetate concentration and trichrome staining methods. Other causes of diarrhea were excluded by microbiologic laboratory tests. Results:,Thirty-eight per cent of siblings of G. lamblia positive patients and 8% of siblings of G. lamblia negative children were found to be positive for G. lamblia cysts and/or trophozoites. The differences between the groups were statistically significant (P < 0.001). Conclusion:,The results suggested that the examination of G. lamblia among the siblings of patients with giardiasis both in the same age group and living in the same household should be considered. [source] Acitretin induced bipedal edemaTHE JOURNAL OF DERMATOLOGY, Issue 5 2006Hong Liang TEY ABSTRACT Generalized edema has been reported to be a rare side effect of systemic retinoids. We report a patient who developed localized bipedal edema from acitretin. Other causes of bipedal edema were excluded and withdrawal of acitretin led to resolution of the edema. [source] Isolated symptomatic cutaneous disease in hypereosinophilic syndromeAUSTRALASIAN JOURNAL OF DERMATOLOGY, Issue 1 2010Veronica Preda ABSTRACT A 41-year-old Phillipino man presented with a 3-year history of a relapsing and remitting generalized chronic pruritic erythematous papular and plaque-like eruption. Investigations showed a persistently elevated eosinophil count. His disease was limited to cutaneous involvement with an absence of demonstrable internal organ involvement, despite extensive investigations and multidisciplinary review. Other causes of eosinophilia were excluded. A diagnosis of idiopathic hypereosinophilic syndrome was made. Our patient's presentation raises a number of issues related to hypereosinophilic syndrome. In particular, relating to managing hypereosinophilic syndrome and the challenge of minimizing therapy side-effects. Our case highlights the considerable morbidity of untreated isolated cutaneous disease, for which he was hospitalized with suicidal ideations. In a minority of reports, skin involvement is the only manifestation of hypereosinophilic syndrome. [source] Anogenital and buttock ulceration in infancyAUSTRALASIAN JOURNAL OF DERMATOLOGY, Issue 1 2002Anne R Halbert SUMMARY Rashes in the anogenital and buttock region are some of the commonest dermatological problems occurring in infancy. The most frequent causes seen in clinical practice are ulcerating haemangiomas, bullous impetigo and severe irritant contact dermatitis. Other causes include nutritional deficiencies, bullous diseases, trauma, Langerhans cell histiocytoses and inflammatory disorders such as pyoderma gangrenosum and Crohn's disease. This review presents a brief overview of these causes and outlines the recommended management strategies. [source] A review of maternal deaths at Goroka General Hospital, Papua New Guinea 2005,2008AUSTRALIAN AND NEW ZEALAND JOURNAL OF OBSTETRICS AND GYNAECOLOGY, Issue 1 2010Karen SANGA Background:, Papua New Guinea is a developing country with a population of six million, facing significant geographical, cultural and economic barriers to the provision of antenatal and intrapartum care. The maternal mortality ratio (MMR) is an internationally regarded index of the quality of a country's maternity services; the most recently reported MMR for Papua New Guinea of 773 deaths per 100 000 births is one of the highest in the world. Aims:, To review information about women who died from pregnancy-related causes, both direct and indirect, in the Goroka General Hospital (GGH) during the period 1st January 2005 to 31st May 2008. Methods:, A retrospective review was undertaken of the charts of women recorded as dying in the Obstetrics and Gynecology (O&G) ward of GGH in the study period. Results:, The charts of 21 women who died from pregnancy-related causes were reviewed and information collated. Puerperal sepsis and sepsis complicating unsafe abortion were the most common causes of maternal death accounting for 48% deaths. Other causes included ectopic pregnancy and postpartum haemorrhage. Contributing factors included residence in a rural area, geographical and transport difficulties accessing care, non-use of family planning services, non-booking for antenatal care and late presentation in pregnancy or labour, and under-resourcing of services at GGH. The socio-economic status of most of the women was low, and where educational attainments were recorded these were also low. 71% of women identified themselves as practising Christians. Conclusions:, Better outreach services to provide health information and antenatal care, with specific counselling about the need for supervised delivery, are urgently required in the Eastern Highlands Province that GGH serves if numbers of maternal deaths are to be reduced. Working through churches in the region may be the most appropriate way to provide information and services to women because a majority of women adhere to Christianity and can be reached in this way. [source] Major Elements in Lake Muhazi, Rwanda, East AfricaACTA GEOLOGICA SINICA (ENGLISH EDITION), Issue 5 2009Jean de la Paix MUPENZI Abstract: The aim of this study undertaken at Lake Muhazi in Rwanda was to determine and analyze the major elements present in water. The presence of many major elements (Al, As, Ba, C, Ca, Cu, Fe, H+, K, Mg, Mn, N, P, S, Si, and Zn) was determined by spectroscopic technique. The concentrations of the elements were measured in water samples taken from three different locations of the lake from May to August 2008. The lake is polluted by water flow from mountain sides surrounding the lake. Other causes of pollution could be the use of agrochemicals in the sugar land, which surrounds the lake, and human activities near the lake. Finally, we proposed the strategies that can be applied in order to ensure good conservation of the environment and to prevent augmentation of heavy materials into the lake. [source] Causes of death in sickle cell disease: an autopsy studyBRITISH JOURNAL OF HAEMATOLOGY, Issue 2 2003Elizabeth A. Manci Summary. More precise analysis of causes of death is needed to focus research efforts and improve morbidity and mortality in sickle cell disease. In this study, the morphological evidence of the cause of death was studied in 306 autopsies of sickle cell disease, which were accrued between 1929 and 1996. The most common cause of death for all sickle variants and for all age groups was infection (33,48%). The terminal infection was heralded by upper respiratory tract syndromes in 72·6% and by gastroenteritis in 13·7%. The most frequent portal of entry in children was the respiratory tract but, in adults, a site of severe chronic organ injury. Other causes of death included stroke 9·8%, therapy complications 7·0%, splenic sequestration 6·6%, pulmonary emboli/thrombi 4·9%, renal failure 4·1%, pulmonary hypertension 2·9%, hepatic failure 0·8%, massive haemolysis/red cell aplasia 0·4% and left ventricular failure 0·4%. Death was frequently sudden and unexpected (40·8%) or occurred within 24 h after presentation (28·4%), and was usually associated with acute events (63·3%). This study shows that the first 24 h after presentation for medical care is an especially perilous time for patients with sickle cell disease and an acute event. Close monitoring and prompt aggressive treatment are warranted. [source] 4132: Factors influencing donor cornea utilization in a tertiary care centre: results from 5-year dataACTA OPHTHALMOLOGICA, Issue 2010P SANKARAN Purpose To evaluate utilization of corneal tissue procured by the eye bank of a tertiary care centre in north India, to determine factors that were responsible for labeling corneas unsuitable for transplantation, and to identify methods to improve donor tissue utilization. Methods We retrospectively reviewed records from our eye bank from May 2005 to April 2010. We compared donor demographics, death- enucleation interval, and biologic contamination of utilized and non- utilized corneal tissues. Results 3951 corneas were received during the study period. Of these, 2561 donor corneas (65%) were used for surgical purposes. Of the 1390 corneas not utilized for transplantation, 703 corneas (50.6%) were excluded due to poor tissue quality. Other causes were logistical reasons, such as no suitable recipient, in 267 (19.2%), bacterial growth on culture in128 (9.2%), contraindication in the donor's medical history in 102(7.3%), and serological results in 83(6%). Mean age of donors in the utilized cornea group was 58.9 years (± 21.57 years) as compared to 67.52 years (± 19.82 years) in the non-utilized cornea group. The difference was statistically significant (P=0.000). Mean death-enucleation interval was comparable in the 2 groups (5.38 hours versus 4.62 hours; P=0.54). Conclusion Increase in age of donors results in poorer tissue quality and emerges as a significant factor in non,utilization of donor corneas for transplantation. [source] Diagnosis of perinatal stroke II: mechanisms and clinical phenotypesACTA PAEDIATRICA, Issue 11 2009P Govaert Abstract Introduction:, Here (and in an accompanying article dealing with definitions, differential diagnosis and registration), a structured sequential diagnostic flow is proposed to discern clinical phenotypes for perinatal stroke, including arterial ischaemic stroke (AIS), cerebral sinovenous thrombosis (CSVT) and haemorrhagic stroke. Material and results:, For neonatal AIS, the diagnostic sequence is infection, trauma, embolism, arteriopathy, other, primary thrombosis and unclassifiable; for neonatal CSVT, the sequence is infection, trauma, venopathy, other, primary thrombosis and unclassifiable. The proposed hierarchical diagnostic flows are an initial step towards a standard for registration of the causes of neonatal stroke. Such standardization should guide attempts at prevention and intervention. An extensive literature search and study of a retrospective cohort of 134 newborn infants with stroke suggest that embolism is the most common identifiable cause for stroke in general (25%), preceding trauma (10%) and infection (8%). Other causes, such as asphyxia, acute blood loss, extracorporeal membrane oxygenation, genetic disorders or prothrombotic conditions, are seen in <5% of cases. For neonatal AIS, the presence of an embolic phenotype is 33% in this cohort. The designation unclassifiable scored 34% for the entire stroke group and 25% for neonatal AIS. Complex arterial stroke with multiple arteries involved is often seen when the underlying cause is infection, cranial trauma or embolism. One important conclusion is that a means of prevention is avoidance of embolism from thrombosis outside the brain. Conclusion:, To prevent the occurrence and recurrence of neonatal ischaemic stroke, clinicians must develop a standardized diagnostic approach that results in characterization of the clinical phenotype. [source] Utility of consecutive repeat HIT ELISA testing for heparin-induced thrombocytopeniaAMERICAN JOURNAL OF HEMATOLOGY, Issue 3 2008Maren Chan Heparin-induced thrombocytopenia (HIT) is a serious complication of heparin therapy. Limited data are available regarding repeat HIT antibody testing after an initial negative test. We conducted a retrospective study to determine the utility of repeat testing. Heparin antibodies were detected using the GTI-PF4 enzyme-linked immunoabsorbent assay, ELISA (GTI Diagnostics, Waukesha, WI). Patients (n = 137) were assigned to one of three groups based upon the initial negative test optical density (OD) range of low = 0,0.132, medium = 0.133,0.267, and high = 0.268,0.399. A pretest clinical score was retrospectively determined using the "4T's" (Thrombocytopenia, Timing of platelet fall, Thrombosis, and the absence of oTher causes of thrombocytopenia). A subsequent positive ELISA was found in 16% (22/137) of patients who underwent repeat testing. Most of these patients had a low pretest clinical score (62%). Four patients had an interval change in the pretest score between the initial negative and subsequent positive tests. Only these four patients developed HIT with thrombosis (HITT). Eighty percent of patients with a high initial negative test OD value had a positive ELISA on repeat testing; however, the initial negative test OD value could not predict whether a patient developed HITT. In contrast, an increase in the pretest clinical probability between initial and repeat testing better predicted HITT. Consecutive repeat ELISA testing for heparin antibodies may be warranted in patients with an increase in their pretest clinical score after an initial negative test as an adjunct to confirm the diagnosis of HIT. Am. J. Hematol., 2008. © 2007 Wiley-Liss, Inc. [source] The impact of atherosclerotic renovascular disease on diabetic renal failureDIABETIC MEDICINE, Issue 11 2002A. J. Nicholls Abstract Atherosclerotic renovascular disease (ARVD) is common in thegeneral population, and its prevalence increases with age. Parallelstudies show it is also common in patients with diabetes. The widespreaduse of angiotensin converting enzyme inhibitors and angiotensin receptorantagonists for heart and kidney disease might therefore expose arteriopathicdiabetic patients to potential harm if they had critical renal arterystenosis. This review looks at the natural history of ARVD in thediabetic and non-diabetic populations: while it is common, it only rarelyleads to renal failure. Hence intervention to revascularize ischaemic kidneyson the basis of radiological appearances alone may subject somepatients to unnecessary therapy. Although untested by randomizedtrial, a policy of watchful waiting may be the simplest strategyfor most diabetic patients with suspected ARVD, reserving angiography andangioplasty (usually backed up by a stent) for those with an abruptdecline in renal function and no other cause for renal deterioration. Futureclinical trials may better define subgroups of patients who will trulybenefit from renal revascularization. [source] Discounting and the role of the relation between causesEUROPEAN JOURNAL OF SOCIAL PSYCHOLOGY, Issue 2 2005Frank Van Overwalle This research investigates how the relation between two causes (i.e. whether they co-occur or not) affects the likelihood to discount one of them. In two experiments, two causes were either systematically paired together (positive relation), were paired with many other causes (independent relation), or were never paired together (negative relation). The results indicate that discounting of one of the causes (target cause) depends on the relation with the other cause (alternative cause) and the order in which the alternative cause was presented and produced the outcome alone. If information on the independent outcome of the alternative cause came prior to the joint outcome of the alternative and target cause (forward order), then discounting of the target cause occurred regardless of the relation between the two causes. If, however, information on the independent outcome of the alternative cause came after the joint outcome of the alternative and target cause (backward order), then discounting of the target cause occurred mainly when there was a positive or negative relation between the causes, but not when there was an independent relation. The degree of backward discounting given a positive or negative relation was largely identical. These results are consistent with the retrospective revaluation hypothesis of Dickinson and Burke (1996) and shed new light on the role of the relation between causes on discounting. Copyright © 2004 John Wiley & Sons, Ltd. [source] Acute liver damage in anorexia nervosaINTERNATIONAL JOURNAL OF EATING DISORDERS, Issue 1 2004Lorenza Di Pascoli Abstract We report a case of a 26-year-old White woman with a history of anorexia nervosa who developed severe liver damage and multiorgan dysfunction. At admission to our medical unit, her body mass index (BMI) was 10.8. Biochemical evaluation showed a marked increase in serum levels of aspartate aminotransferases (AST = 9,980 IU/L), alanine aminotransferase (ALT = 3,930 IU/L), amylase (1,002 IU/L), lipase (1,437 IU/L), creatine phosphokinase (CPK; 783 IU/L), and lactate dehydrogenase (LDH = 6,830 IU/L). Glomerular filtration rate was reduced (35 ml/min), reflecting dehydration and prerenal azotemia. No other cause of acute liver damage except malnutrition was evidenced. Hydration and nutritional support were the unique medical treatment. A rapid recovery occurred in few days and all laboratory data were normal at discharge after a 37-day hospitalization. © 2004 by Wiley Periodicals, Inc. Int J Eat Disord 36: 114,117, 2004. [source] Prevalence and risk factors of hepatic steatosis and its impact on liver injury in Chinese patients with chronic hepatitis B infectionJOURNAL OF GASTROENTEROLOGY AND HEPATOLOGY, Issue 9 2008Jun-ping Shi Abstract Background and Aims:, The clinical significance of hepatic steatosis in chronic hepatitis B infection (CHB) is unclear. The aims of this study were thus to investigate the prevalence and risk factors for hepatic steatosis in patients with CHB and its relationship with liver injury. Methods:, Consecutive patients with biopsy-proven CHB at Hangzhou Sixth People's Hospital between January 2005 and June 2007 were included. Patients co-infected with other viruses or suffering from liver disease of any other cause were excluded. Liver steatosis, necroinflammation and fibrosis were assessed by both Brunt and Scheuer classifications. Results:, A total of 1915 patients (1497 men) with a mean age of 31 ± 9.5 years were analyzed. Hepatic steatosis was present in 260 (14%) patients. The steatosis involved < 33% of hepatocytes in 90% of cases, and was more frequent among men than women (15% vs 8%, P < 0.001). Two-thirds (178 of 260) of patients with steatosis were hepatitis B e antigen (HBeAg)-positive, but there was no correlation with either serum HBeAg status or hepatitis B virus DNA titer. Degree of inflammation and fibrosis were more mild among those with steatosis than those without. Multivariate analysis showed that steatosis was independently associated with body mass index, serum triglyceride, apolipoprotein B, uric acid, and fasting blood glucose. However, fibrosis was only independently associated with age and inflammatory grade, and the latter associated with viral load and fibrosis stage. Conclusions:, Hepatic steatosis is common in CHB, it is associated with metabolic factors not viral ones, and does not appear to affect the severity of liver disease. [source] Candida balanitis: risk factorsJOURNAL OF THE EUROPEAN ACADEMY OF DERMATOLOGY & VENEREOLOGY, Issue 7 2010C Lisboa Abstract Background, The amount of available information on the prevalence and incidence of candida balanitis is still surprisingly scarce. Objectives, To determine the prevalence of candida colonization and candida balanitis in men attending a Sexually Transmitted Diseases (STD) clinic. To identify risk factors associated with candida balanitis. Methods, During a 36-month period, a cross-sectional study was carried out on consecutive men attendees of the STD clinic in Hospital S. João, Porto. Clinical and epidemiological data were recorded. Specimen collection from the glans penis and the coronal sulcus followed two procedures: a cotton tipped swab and the direct impression on the surface of CHROMagar Candida medium. Risk factors were considered singly and in combination through logistic regression models. Results, Among 478 men enrolled, the prevalence of candida colonization was 26.2% and the prevalence of candida balanitis was 18%. Candida colonization was strongly associated with an age above 60 years (OR = 3.375; 95% CI: 1.547,7.362) and with the presence of other cause of balanitis apart from Candida organisms (OR: 2.466; 95% CI: 1.491,4.078). An age above 40 years (OR: 2.27; 95% CI: 1.005,4.500), diabetes mellitus (OR: 19.390; 95% CI: 7.789,48.273) and more than ten candida colonies recovered by culture (OR: 9.586; 95% CI: 2.682,34.263) were risk factors for candida balanitis. Conclusions, This study highlights the impact of factors other than sexual behaviours upon the epidemiology of this infection. For both candida colonization and infection, age was an important risk factor. Diabetes mellitus was an independent risk factor for candida balanitis. More than ten colonies recovered from culture are associated with clinical signs and symptoms. [source] Pulmonary hemorrhage/hemoptysis in childrenPEDIATRIC PULMONOLOGY, Issue 6 2004Simon Godfrey MD Abstract Pulmonary hemorrhage and hemoptysis are uncommon in childhood, and the frequency with which they are encountered by the pediatric pulmonologist depends largely on the special interests of the center to which the child is referred. In those centers caring for children with cystic fibrosis or congenital heart disease, these will be by far the most common causes of hemoptysis. Other causes of hemoptysis are far less common, such as bleeding from localized lesions in the upper airway or tracheobronchial tree. Even less common is bleeding into the lungs as part of a systemic disease, usually with renal involvement (pulmonary-renal syndromes), such as systemic lupus erythematosis or Goodpasture's syndrome. Bleeding into the lungs in children with a bleeding diathesis probably only occurs in immunosuppressed children after transplantation. When no other cause is found for pulmonary hemorrhage, the presumed diagnosis is idiopathic pulmonary hemosiderosis. This review discusses the various causes of hemoptysis and pulmonary hemorrhage, and the appropriate investigations to aid in determining the correct diagnosis. The management and prognosis of idiopathic pulmonary hemosiderosis, based on cumulative experience from published reports, are considered in more detail. Pediatr Pulmonol. 2004; 37:476,484. © 2004 Wiley-Liss, Inc. [source] TEM and FISH studies in sperm from men of couples with recurrent pregnancy lossANDROLOGIA, Issue 6 2009G. Collodel Summary The role of the male partner in recurrent pregnancy loss (RPL) is not clear. In this study, semen characteristics of 22 men whose partners had experienced RPL were examined by light microscopy. Sperm morphology was analysed by transmission electron microscopy (TEM) and the data were mathematically elaborated to obtain numerical indices expressing the status of an ejaculate: the fertility index and the percentage of apoptosis, necrosis and immaturity. Sperm apoptosis and necrosis were also evaluated by annexin V/propidium iodide assay. To explore the status of meiotic segregation, fluorescence in situ hybridisation (FISH) with probes for chromosomes 18, X and Y, was applied directly on sperm nuclei. Sperm characteristics from a group of men of proven fertility were used as controls. Among the considered sperm characteristics, apoptosis (P < 0.01), 1818YY diploidy (P < 0.05) and 18YY disomy (P < 0.01) scores were significantly higher in men with RPL compared with controls. Our study showed that some patients with normal semen parameters can present a slight increase in aneuploidy compared with controls, indicating a possible involvement of sperm in some cases of RPL. Chromosomal FISH analysis and chromatin tests of sperm could be included in RPL work-ups when no other cause has been detected. [source] Antimalarial treatment may have a time-dependent effect on lupus survival: Data from a multinational Latin American inception cohortARTHRITIS & RHEUMATISM, Issue 3 2010Samuel K. Shinjo Objective To evaluate the beneficial effect of antimalarial treatment on lupus survival in a large, multiethnic, international longitudinal inception cohort. Methods Socioeconomic and demographic characteristics, clinical manifestations, classification criteria, laboratory findings, and treatment variables were examined in patients with systemic lupus erythematosus (SLE) from the Grupo Latino Americano de Estudio del Lupus Eritematoso (GLADEL) cohort. The diagnosis of SLE, according to the American College of Rheumatology criteria, was assessed within 2 years of cohort entry. Cause of death was classified as active disease, infection, cardiovascular complications, thrombosis, malignancy, or other cause. Patients were subdivided by antimalarial use, grouped according to those who had received antimalarial drugs for at least 6 consecutive months (user) and those who had received antimalarial drugs for <6 consecutive months or who had never received antimalarial drugs (nonuser). Results Of the 1,480 patients included in the GLADEL cohort, 1,141 (77%) were considered antimalarial users, with a mean duration of drug exposure of 48.5 months (range 6,98 months). Death occurred in 89 patients (6.0%). A lower mortality rate was observed in antimalarial users compared with nonusers (4.4% versus 11.5%; P< 0.001). Seventy patients (6.1%) had received antimalarial drugs for 6,11 months, 146 (12.8%) for 1,2 years, and 925 (81.1%) for >2 years. Mortality rates among users by duration of antimalarial treatment (per 1,000 person-months of followup) were 3.85 (95% confidence interval [95% CI] 1.41,8.37), 2.7 (95% CI 1.41,4.76), and 0.54 (95% CI 0.37,0.77), respectively, while for nonusers, the mortality rate was 3.07 (95% CI 2.18,4.20) (P for trend < 0.001). After adjustment for potential confounders in a Cox regression model, antimalarial use was associated with a 38% reduction in the mortality rate (hazard ratio 0.62, 95% CI 0.39,0.99). Conclusion Antimalarial drugs were shown to have a protective effect, possibly in a time-dependent manner, on SLE survival. These results suggest that the use of antimalarial treatment should be recommended for patients with lupus. [source] Treatment of pruritus by capsaicin in a patient with pityriasis rubra pilaris receiving RE-PUVA therapyCLINICAL & EXPERIMENTAL DERMATOLOGY, Issue 3 2000Clinical dermatology, Concise report Pityriasis rubra pilaris (PRP) is characterized by redness of the skin, scaling and a variable degree of pruritus. We present a patient with extremely itchy PRP successfully treated with oral retinoids and photochemotherapy with 8-methoxypsoralene (RE-PUVA) and topical capsaicin. The PRP-related pruritus which clearly preceded photochemotherapy and for which no other cause was apparent was relieved with capsaicin. This single case report provides evidence that topical capsaicin may be a useful therapeutic option in treating PRP-associated pruritus where antihistamines have been unsuccessful. [source] Hyperthermia in utero due to maternal influenza is an environmental risk factor for schizophreniaCONGENITAL ANOMALIES, Issue 3 2007Marshall J. Edwards ABSTRACT A hypothesis is presented that the association between maternal influenza and other causes of fever during the second trimester of pregnancy and the subsequent development of schizophrenia in the child is due to the damage caused by hyperthermia to the developing amygdalohippocampal complex and associated structures in the fetal brain. Hyperthermia is a known cause of congenital defects of the central nervous system and other organs after sufficiently severe exposures during early organogenesis. The pathogenic mechanisms include death of actively dividing neuroblasts, disruption of cell migration and arborization and vascular damage. In experimental studies, hyperthermia during later stages of central nervous system development also caused damage to the developing brainstem that was associated with functional defects. This damage usually results in hypoplasia of the parts undergoing active development at the time of exposure. Recent studies have shown no evidence of direct invasion of the fetus by the influenza virus. Factors that might interact with hyperthermia include familial liability to schizophrenia, season of birth, maternal nutrition, severe stress and medications used to alleviate the symptoms of fevers. The time of the development of the fetal amygdalohippocampal complex and the changes found in its structure and associated areas of the brain are compatible with the known effects of hyperthermia. [source] Conservation of Brazilian AmphibiansCONSERVATION BIOLOGY, Issue 3 2005DÉBORA L. SILVANO The Brazilian Official List of Threatened Species and the results of a workshop for the Global Amphibian Assessment indicate that 26 species are threatened. The majority of these occur in the Atlantic Forest, one of the world's biodiversity hotspots. The main threat to amphibians is the destruction of their habitats through deforestation, conversion into agricultural land, mining, wildfires, and infrastructure development and urbanization. In Brazil little is known about other causes of amphibian decline observed worldwide, such as pesticides, infectious diseases, climate change, invasive species, or wildlife trade. Brazilian conservation policies include such important legal instruments as the Official List of Threatened Species and the selection of priority areas for conservation measures in all of Brazil's major biomes. Although there is little information on geographic distributions and the natural history and ecology of the large majority of the currently recognized species, a number of important regional studies for amphibian conservation are under way. New species are discovered each year. Resumen:,Brasil es el líder mundial en diversidad de anfibios, con 765 especies, la mayoría de las cuales han sido descritas en los últimos 40 años. La Lista Brasileña Oficial de Especies Amenazadas y los resultados de un taller para la Evaluación Global de Anfibios indican que 26 especies están amenazadas, la mayoría de ellas ocurre en el Bosque Atlántico, uno de los sitios de importancia para la biodiversidad global. La principal amenaza a los anfibios es la destrucción de sus hábitats por la deforestación, conversión a tierras agrícolas, minería, fuego no controlado, desarrollo de infraestructura y urbanización. En Brasil se conoce poco sobre otras causas de la declinación de anfibios observadas en todo el mundo, como pesticidas, enfermedades infecciosas, cambio climático, especies invasoras o comercio de vida silvestre. Las políticas Brasileñas de conservación incluyen importantes instrumentos legales como la Lista Oficial de Especies Amenazadas y la selección de áreas prioritarias para la conservación en todos lo biomas principales de Brasil. Existe escasa información sobre la distribución geográfica y la historia natural y ecología de la gran mayoría de las especies reconocidas actualmente, aunque se está desarrollando un importante número de estudios regionales para la conservación de anfibios. Cada año se descubren nuevas especies. [source] ORGANIZATIONAL PORTFOLIO THEORY: PERFORMANCE-DRIVEN ORGANIZATIONAL CHANGECONTEMPORARY ECONOMIC POLICY, Issue 4 2000L DONALDSON The article outlines some of the main ideas of a new organizational theory: organizational portfolio theory. The literature has empirically established that organizations tend not to make needed adaptive changes until they suffer a crisis of low organizational performance. Organizational portfolio theory takes this idea and constructs a theory of the conditions under which organizational performance becomes low enough for adaptive organizational change to occur. The focus is on the interaction between organizational misfit and the other causes of organizational performance. To model these interactions use is made of the concepts of risk and portfolio. [source] | ||||||||||||||||||||||||||||||||||||||||