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Specific Treatment (specific + treatment)
Selected AbstractsMaternal transmission of diabetesDIABETIC MEDICINE, Issue 2 2002J. C. Alcolado Abstract Type 2 diabetes mellitus represents a heterogeneous group of conditions characterized by impaired glucose homeostasis. The disorder runs in families but the mechanism underlying this is unknown. Many, but not all, studies have suggested that mothers are excessively implicated in the transmission of the disorder. A number of possible genetic phenomena could explain this observation, including the exclusively maternal transmission of mitochondrial DNA (mtDNA). It is now apparent that mutations in mtDNA can indeed result in maternally inherited diabetes. Although several mutations have been implicated, the strongest evidence relates to a point substitution at nucleotide position 3243 (A to G) in the mitochondrial tRNAleu(UUR) gene. Mitochondrial diabetes is commonly associated with nerve deafness and often presents with progressive non-autoimmune ,-cell failure. Specific treatment with Coenzyme Q10 or L-carnitine may be beneficial. Several rodent models of mitochondrial diabetes have been developed, including one in which mtDNA is specifically depleted in the pancreatic islets. Apart from severe, pathogenic mtDNA mutations, common polymorphisms in mtDNA may contribute to variations of insulin secretory capacity in normal individuals. Mitochondrial diabetes accounts for less than 1% of all diabetes and other mechanisms must underlie the maternal transmission of Type 2 diabetes. Possibilities include the role of maternally controlled environments, imprinted genes and epigenetic phenomena. [source] Hypercalcaemia of malignancy: an undiagnosed and undertreated diseaseJOURNAL OF INTERNAL MEDICINE, Issue 1 2001O. Lamy Lamy O, Jenzer-Closuit A, Burckhardt P (University Hospital, Lausanne, Switzerland). Hypercalcaemia of malignancy: an undiagnosed and undertreated disease. J Intern Med 2001; 250: 73,79. Background.,Hypercalcaemia of malignancy, a relatively frequent phenomenon, seems to be insufficiently recognized and treated. Its symptoms are not specific, but they affect the quality of life. Methods.,A prospective study to analyse the influence of symptoms caused by hypercalcaemia on the decision of the admitting physician, the motivation for treatment, and the effect of the treatment on the given symptoms in hospitalized patients with oncologic disease in progression, where confounding causes of similar symptoms such as cerebral metastasis, radiotherapy, treatment with opioids, etc., were excluded. Results.,A total of 71 patients, mean age 65 + 11 years, fulfilled the strict inclusion criteria. About 42% were hospitalized because of symptoms caused by hypercalcaemia, but none of the medical reports mentioned hypercalcaemia as reason for hospitalization. Specific antihypercalcaemic therapy was given to only 37% of patients, and only 25% got an adequate rehydratation. Antihypercalcaemic treatment was guided by the severity of hypercalcaemia (>3.00 mmol L,1), not by the symptoms. Polyuria-polydipsia, nausea-vomiting and constipation were correlated with hypercalcaemia. These symptoms, as well as confusion-stupor and bone pains improved significantly when calcaemia was normalized. Patients with calcaemia normalized returned home most frequently (P < 0.03). Conclusions.,Malignant hypercalcaemia remains mostly undiagnosed in medical praxis. Specific treatment occurs in too small fractions of the patients. As the normalization of calcaemia significantly improves the symptoms because of hypercalcaemia and the quality of life, rapid rehydration and specific calcium lowering treatments should be part of palliative measures in all patients with malignant hypercalcaemia. [source] Treatment of hepatitis C virus infection in intravenous drug usersACTA NEUROPSYCHIATRICA, Issue 5 2006Matthew L Cowan Background:, Hepatitis C virus (HCV) infection is common among intravenous drug users, and because of the long latent period, HCV liver disease is set to increase. Objectives:, We sought to examine practice guidelines regarding treatment of HCV in drug users and to review the evidence for current practices. Methods:, A structured search of the Pubmed database, websites of the National Institute for Clinical Excellence and national and international expert groups and opinion of independent experts in the field. Results and Conclusions:, All those infected with HCV need to be assessed to ascertain whether they have active ongoing viral replication and the extent of liver damage. HCV-infected individuals should be educated about the modes of transmission and means of reducing the risk of infecting others. They should also be advised to avoid cofactors (especially alcohol) that accelerate the progression of liver disease. Specific treatment with antivirals can cause viral clearance and prevent the progression of liver disease. Therapy is effective in those on opiate-replacement treatments and also in motivated individuals who continue to use intravenous drugs. The decision whether to treat drug users should be made jointly by specialists in the management of viral hepatitis and addiction on a case-by-case basis. Current combination drug regimens are expensive but are claimed to be cost-effective, and are certainly much less costly than managing end-stage liver disease. In addition to satisfactory sustained viral response rates, other benefits such as a beneficial effect on drug habit, self-esteem and rehabilitation have been reported. Encouraging suitable drug users to take-up and comply with treatment seems to be more easily achieved in supportive drug dependency unit settings (rather than the more formal surroundings of a hospital clinic). [source] Belatacept as Maintenance Immunosuppression for Postrenal Transplant de novo Drug-Induced Thrombotic MicroangiopathyAMERICAN JOURNAL OF TRANSPLANTATION, Issue 2 2009N. Ashman De novo posttransplant thrombotic microangiopathy (TMA) is a complication of solid organ transplantation, which remains difficult to treat. In many cases, immunosuppressants and particularly calcineurin inhibitors, trigger TMA. Although withdrawing the offending drug may lead to resolution of TMA, graft and patient outcomes are poor. Specific treatments, including plasma exchange, have not gained widespread acceptance in those with fulminant disease and new approaches to the condition are urgently needed. We report a case of posttransplant de novo TMA presenting serially in association with ciclosporin, tacrolimus and sirolimus in a young recipient of a living donor kidney transplant. We describe a patient treated with belatacept, a novel CTLA4 Ig fusion protein, as ongoing maintenance immunosuppression to allow avoidance of conventional agents once associated with TMA. We report excellent early graft outcome, with no adverse events using this strategy. We suggest that belatacept may have a role in this traditionally difficult-to-treat group of patients. [source] Multidisciplinary approach of complicated crown fractures of both superior central incisors: a case reportDENTAL TRAUMATOLOGY, Issue 4 2008Anca Silvia Vâlceanu Since the development of the adhesive dentistry, many case reports of crown fractures restored using adhesive reattachment techniques were published. Complex cases, in which more than one tooth are involved, with fractures differing from each other, require specific treatment of each fracture, taking different advantages of the different remaining tooth structures. This case report describes a patient with dissimilar crown fractures of both superior central incisors. After the endodontic treatment, the patient was treated using the combination of several techniques: periodontal surgery (crown lengthening with apically repositioned flap and osseous resective surgery), adhesive technique and cast restoration plus esthetic crown. The periodontal procedure re-created the biologic width and proved to be a reliable adjunctive procedure to the adhesive and the prosthetic techniques used. [source] On the Spatial Dynamics of Democratic Politics: Analysing the Bolivian CaseDEVELOPMENT AND CHANGE, Issue 4 2003David Slater After an initial discussion of the ,diverse spaces of democracy', which sets out the main points of the author's approach to democratic politics, this article considers three perspectives on the relations between governmental decentralization and territorial democracy in Latin America. These two interrelated sections provide a thematic and conceptual background to a more specific treatment of the development and dynamics of decentralization in the Bolivian case. In examining the decentralization process in Bolivia, the article highlights the two spatial modes of this process , the regional and the local , and includes an appraisal of the relation between both modes and the nature of democratic politics. [source] Genetic aspects of pathological gambling: a complex disorder with shared genetic vulnerabilitiesADDICTION, Issue 9 2009Daniela S. S. Lobo ABSTRACT Aims To summarize and discuss findings from genetic studies conducted on pathological gambling (PG). Methods Searches were conducted on PubMed and PsychInfo databases using the keywords: ,gambling and genes', ,gambling and family' and ,gambling and genetics', yielding 18 original research articles investigating the genetics of PG. Results Twin studies using the Vietnam Era Twin Registry have found that: (i) the heritability of PG is estimated to be 50,60%; (ii) PG and subclinical PG are a continuum of the same disorder; (iii) PG shares genetic vulnerability factors with antisocial behaviours, alcohol dependence and major depressive disorder; (iv) genetic factors underlie the association between exposure to traumatic life-events and PG. Molecular genetic investigations on PG are at an early stage and published studies have reported associations with genes involved in the brain's reward and impulse control systems. Conclusions Despite the paucity of studies in this area, published studies have provided considerable evidence of the influence of genetic factors on PG and its complex interaction with other psychiatric disorders and environmental factors. The next step would be to investigate the association and interaction of these variables in larger molecular genetic studies with subphenotypes that underlie PG. Results from family and genetic investigations corroborate further the importance of understanding the biological underpinnings of PG in the development of more specific treatment and prevention strategies. [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] SUNCT Syndrome Responsive to LamotrigineHEADACHE, Issue 8 2002Jose M. Gutierrez-Garcia MD Background.,Short-lasting, unilateral, neuralgiform headache attacks with conjunctival injection, tearing, rhinorrhea (SUNCT syndrome) is a headache form generally refractory to drug therapy. Occasional patients with SUNCT have been reported with a successful response to lamotrigine. Objective.,To report two patients with SUNCT treated with lamotrigine. Methods.,Clinical history, neurologic examination, and brain magnetic resonance imaging. Results.,Both patients with SUNCT syndrome were successfully treated with lamotrigine. In both cases, when lamotrigine was tapered off, the attacks reappeared, only to disappear when the dose was again increased. In addition, lamotrigine was well tolerated and no undesired side-effects were reported. Conclusion.,If the positive effect of lamotrigine in patients with SUNCT is confirmed in other cases, lamotrigine could become the first specific treatment for SUNCT syndrome. [source] Antisense therapeutics for neurofibromatosis type 1 caused by deep intronic mutations,HUMAN MUTATION, Issue 3 2009Eva Pros Abstract Neurofibromatosis type 1 (NF1) is an autosomal dominant disorder affecting 1:3,500 individuals. Disease expression is highly variable and complications are diverse. However, currently there is no specific treatment for the disease. NF1 is caused by mutations in the NF1 gene, approximately 2.1% of constitutional mutations identified in our population are deep intronic mutations producing the insertion of a cryptic exon into the mature mRNA. We used antisense morpholino oligomers (AMOs) to restore normal splicing in primary fibroblast and lymphocyte cell lines derived from six NF1 patients bearing three deep intronic mutations in the NF1 gene (c.288+2025T>G, c.5749+332A>G, and c.7908-321C>G). AMOs were designed to target the newly created 5, splice sites to prevent the incorporation of cryptic exons. Our results demonstrate that AMO treatment effectively restored normal NF1 splicing at the mRNA level for the three mutations studied in the different cell lines analyzed. We also found that AMOs had a rapid effect that lasted for several days, acting in a sequence-specific manner and interfering with the splicing mechanism. Finally, to test whether the correction of aberrant NF1 splicing also restored neurofibromin function to wild-type levels, we measured the amount of Ras-GTP after AMO treatment in primary fibroblasts. The results clearly show an AMO-dependent decrease in Ras-GTP levels, which is consistent with the restoration of neurofibromin function. To our knowledge this is the first time that an antisense technique has been usedsuccessfully to correct NF1 mutations opening the possibility of a therapeutic strategy for this type of mutation not only for NF1 but for other genetic disorders. Hum Mutat 30, 454,462, 2009. © 2009 Wiley-Liss, Inc. [source] Studies of scleroderma at The Alfred Hospital, MelbourneINTERNAL MEDICINE JOURNAL, Issue 8 2006A. J. Barnett Abstract Scleroderma had been virtually unrecognized in this country before this study. Our interest in this condition was raised by the discovery that certain patients being investigated for ischaemic disease of the hand had scleroderma. Although uncommon, it is not excessively rare and we have been able to study an increasingly large number of patients, eventually resulting in 177 patients over a period of 35 years. The clinical features in these patients have been delineated. At first, the patients were subdivided into types: type 1, skin changes obvious only in the hands; type 2, skin changes extending beyond the hands but excluding the trunk; type 3, skin changes diffuse and involving the trunk. All types have similar visceral changes, but these are more severe and there is a worse prognosis in type 3 patients. Types 1 and 2 can conveniently be combined as acrosclerosis. Types 1 and 2 have a similar and good prognosis with survival at 30 years of 40%. Type 3 patients have a much worse prognosis, with no type 3 patients living more than 20 years. All types have a high incidence of autoantibodies, but these are generally not related to the severity of the disease and do not occur in relatives or spouses, this being the evidence of the absence of hereditary and environmental factors in their presence. Although patients may receive much relief from symptomatic measures, no treatment had lessened the skin stiffness and there is no specific treatment for the visceral lesions. The cause of the condition remains unknown. [source] Spontaneous resolution of a delayed granulomatous reaction to cosmetic tattooINTERNATIONAL JOURNAL OF DERMATOLOGY, Issue 1 2008Brad Jones MBBS, MPhil(Path) A 27-year-old woman presented with linear, flesh-colored papules along her vermillion borders, 4 years after a cosmetic lip tattoo was applied. A biopsy of the lesion was performed and histology showed it to be a granulomatous reaction surrounding the tattoo pigment. Following the biopsy, the lesions began to resolve spontaneously within 4 weeks and were not noticeable at a follow-up review. Granulomatous reactions are rare after cosmetic facial tattoos and may respond to topical corticosteroids or laser ablation. We present a unique report of a delayed granulomatous reaction to a cosmetic tattoo completely resolving without any specific treatment. [source] Chagas' disease reactivation with skin symptoms in a patient with kidney transplantINTERNATIONAL JOURNAL OF DERMATOLOGY, Issue 6 2007Verónica Gallerano MD Immunodepressed patients in the intermediate phase of Chagas' disease may undergo reactivation of the disease together with atypical symptoms. The case of an immunodepressed kidney transplant patient with reactivation of Chagas' disease with skin symptoms is reported. A 65-year-old man presented with infiltrated erythematous lesions on the anterior aspect of the right thigh of 2 weeks' duration. The lesions later extended to the abdomen, thorax, and lower limbs. In the histologic skin examination, amastigotes and Trypanosoma cruzi trypoamastigotes were observed. A fresh smear showed positive parasitemia. Using the Strout hemoconcentration method, multiple Trypanosoma cruzi trypoamastigotes with motility could be seen. Polymerase chain reaction was positive for Trypanosoma cruzi. An immunofluorescence test was positive (1 : 64) and there was hemoagglutination (1 : 32). Treatment was started with benznidazole, 7 mg/kg/day. The patient did not evolve favorably and died 20 days after hospitalization. Skin lesions may be a manifestation of the reactivation of Chagas' disease in immunosuppressed patients. All patients with positive Chagas' serology who require immunosuppressant drugs should receive specific treatment for Chagas' disease. [source] Unusual case of cutaneous tuberculosis associated with rheumatoid arthritis: a case report and literature reviewINTERNATIONAL JOURNAL OF DERMATOLOGY, Issue 12 2002G. Faghihi MD We report a 47-year-old female patient with a 10-year history of rheumatoid arthritis who presented with painful ulcerative plaques on the extremities at our clinic in St. Zahra University Hospital on February 2001. These plaques, diagnosed as cutaneous leishmaniasis, were 2 years old, but the patient was without any cure from the specific treatment she had been prescribed. Later, these skin lesions were misdiagnosed as pyoderma gangrenosum and she was treated by high-dose oral prednisolone, but she did not improve at all. After she was referred to our clinic, routine laboratory tests, PPD, chest X-ray and skin biopsy with tissue cultures were carried out. Finally, her cutaneous lesions turned out to be cutaneous tuberculosis, which responded successfully to antituberculosis treatment. [source] Rheumatological presentations of anticoagulation related hemorrhagesINTERNATIONAL JOURNAL OF RHEUMATIC DISEASES, Issue 2 2003S. R. Cox Abstract Background: Joint, back and muscle pain are common in patients referred to a rheumatology unit. Acute pain due to hemorrhage may be difficult to distinguish from more common causes of pain in these patients. This article describes a small case-series of patients who presented acutely with hemarthroses, spinal hemorrhage or muscle hematomas while receiving anticoagulant treatment. Methods: Case notes of nine patients were reviewed retrospectively. The demographic characteristics, indication for anticoagulation, international normalized ratio, and management were evaluated. Results: The majority of hemorrhages occurred when the INR was within the therapeutic range. Anticoagulation was held in all cases. Joint aspiration was performed in all cases of hemarthrosis. Surgical intervention was required in management of the spinal epidural bleed and also in one case of muscle hematoma. Conclusion: Cases described represent major hemorrhages in anticoagulated patients. There is little literature on specific treatment and prognosis, particularly with respect to hemarthrosis, and further studies are needed. [source] Transurethral needle ablation of the prostate: An initial Japanese clinical trialINTERNATIONAL JOURNAL OF UROLOGY, Issue 3 2001Masaru Murai Abstract Objectives: Transurethral needle ablation of the prostate is a new alternative endoscopic thermal therapy that uses a low-energy radio frequency delivered into the prostatic adenoma. Herein is reported the initial clinical experience by multiple institutes in Japan of transurethral needle ablation of the prostate for the treatment of symptomatic benign prostatic hyperplasia. Methods: A total of 93 patients were treated with this technique. Transurethral needle ablation of the prostate was generally performed under low-spinal anesthesia. Before and after the procedure, international symptom score (IPSS), quality of life (QOL) score, peak urinary flow rate (Qmax), postvoid residual urine volume and prostate size were evaluated. Results: There was a reduction of IPSS of more than 50% when compared with that of pretreatment, being 51.3% (57/93 patients) and 60.2% (56/93 patients) at 3 months and 6 months after the procedure, respectively. Sixty-seven patients who were available for a 12-month follow-up period demonstrated a markedly decreased mean IPSS when compared with that measured before the treatment for a statistically significant difference (P < 0.01). Fifty-eight patients who were available for uroflowmetric study at 12 months exhibited a notably increased mean Qmax of 11.2 ± 4.5 mL/s, which was a statistically significant increase when compared with that found before treatment (P < 0.05). Although all patients suffered some degree of gross hematuria after the procedure, none of them required any specific treatment for complications. Conclusion: Transurethral needle ablation technique for the treatment of symptomatic benign prostatic hyperplasia is safe and effective. However, a much longer follow-up study is essential for fully evaluating the extended effectiveness of this technique. [source] Fabry Disease: Treatment and diagnosisIUBMB LIFE, Issue 11 2009Paula A. Rozenfeld Abstract Fabry disease is an X-linked lysosomal disorder that results from a deficiency of the lysosomal enzyme ,-galactosidase A leading to accumulation of glycolipids, mainly globotriaosylceramide in the cells from different tissues. Classical Fabry disease affects various organs. Clinical manifestations start at early age and include angiokeratoma, acroparesthesia, hypohydrosis, heat/exercise intolerance, gastrointestinal pain, diarrhea, and fever. The main complications of Fabry disease are more prominent after the age of 30 when kidney, heart, and/or cerebrovascular disorders appear. Most of the heterozygous females are symptomatic. Enzyme replacement therapy (ERT) is the only specific treatment for Fabry disease. The beneficial effect of ERT on different organs/systems has been extensively evaluated. Quality of life of patients receiving ERT is improved. Enzyme replacement stabilizes or slows the decline in renal function and reduces left ventricular hypertrophy. Fabry disease may be underdiagnosed because of nonspecific and multiorgan symptoms. Different screening strategies have been carried out in different at-risk populations in order to detect undiagnosed Fabry patients. An increasing knowledge about Fabry disease within the medical community increases the chances of patients to receive a timely diagnosis and, consequently, to access the appropriate therapy. © 2009 IUBMB IUBMB Life, 61(11): 1043,1050, 2009 [source] Routine chest X-ray is not required after a low-risk central venous cannulationACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 9 2009A. PIKWER Background: Knowledge of the radiographic catheter tip position after central venous cannulation is normally not required for short-term catheter use. Detection of a possible iatrogenic pneumothorax may nevertheless justify routine post-procedure chest X-ray. Our aim was to design a clinical decision rule to select patients for radiographic evaluation after central venous cannulation. Methods: A total of 2230 catheterizations performed using external jugular, internal jugular or subclavian venous approaches during a 4-year period were included consecutively. Information on patient data and corresponding procedures was recorded prospectively. A post-procedure chest X-ray was obtained after each cannulation. Results: Thirteen cases (0.58%) of cannulation-associated pneumothorax were identified. The risk of pneumothorax after a technically difficult (1.8%) or subclavian (1.6%) cannulation was significantly higher than after cannulation not considered as difficult (0.37%) or performed using other routes (0.33%). Clinical signs of pneumothorax within 8 h of cannulation were found in all seven patients with pneumothorax requiring specific treatment. A new clinical decision rule for radiographic evaluation after central venous cannulation based on the results of the present study shows that 48% of the post-procedure chest X-rays performed in our patients were clinically redundant. Conclusion: Clinical symptoms were reported in all patients with pneumothorax requiring specific treatment. Approximately half of the post-procedure chest X-ray controls could be avoided using the proposed clinical decision rule to select patients for radiographic evaluation after central venous cannulation. A large prospective multi-centre study should be carried out to further evaluate this decision rule. [source] Preonset Studies of Spondyloepiphyseal Dysplasia Tarda Caused by a Novel 2-Base Pair Deletion in SEDL Encoding Sedlin,JOURNAL OF BONE AND MINERAL RESEARCH, Issue 12 2001Steven Mumm Abstract Spondyloepiphyseal dysplasia tarda (SEDT), an X-linked recessive skeletal disorder, presents with disproportionate short stature and "barrel-chest" deformity in affected (hemizygous) adolescent boys. In four reported families to date, mutations in a gene designated SEDL (spondyloepiphyseal dysplasia late) cosegregate with SEDT. We diagnosed SEDT in a short-stature, kyphotic 15-year-old boy because of his characteristic vertebral malformations. Clinical manifestations of SEDT were evident in at least four previous generations. A novel 2-base pair (bp) deletion in exon 5 of SEDL was found in the propositus by polymerase chain reaction (PCR) amplification and sequencing of all four coding exons. The mutation ATdel241-242 cosegregated with the kindred's skeletal disease. The deletion is adjacent to a noncanonical splice site for exon 5 but does not alter splicing. Instead, it deletes 2 bp from the coding sequence, causing a frameshift. A maternal aunt and her three young sons were investigated subsequently. Radiographs showed subtle shaping abnormalities of her pelvis and knees, suggesting heterozygosity. X-rays of the spine and pelvis of her 8-year-old son revealed characteristic changes of SEDT, but her younger sons (aged 6 years and 3 years) showed no abnormalities. SEDL analysis confirmed that she and only her eldest boy had the 2-bp deletion. Molecular testing of SEDL enables carrier detection and definitive diagnosis before clinical or radiographic expression of SEDT. Although there is no specific treatment for SEDT, preexpression molecular testing of SEDL could be helpful if avoiding physical activities potentially injurious to the spine and the joints proves beneficial. [source] Explaining inequalities in access to treatment in lung cancerJOURNAL OF EVALUATION IN CLINICAL PRACTICE, Issue 5 2006Ruth H. Jack MSc Abstract Background, Geographical inequalities in lung cancer treatment and patient survival have been described. We hypothesized that lung cancer patients' access to treatment may be influenced by deprivation and the pathway to care. Methods, Case notes were reviewed for patients resident in south-east London who were registered with lung cancer at the Thames Cancer Registry in 1998. Use of surgery, chemotherapy, radiotherapy or any specific treatment and one-year survival were examined. Analyses were adjusted for age, sex, histology, stage and basis of diagnosis. Results, Data for 695 out of 958 (73%) patients were analysed. Subjects who were initially referred to a specialist in thoracic medicine, surgery or oncology were more likely to receive active treatment (71%) than subjects who were referred to other consultants (51%) or who were admitted as emergencies (42%) (P < 0.0001). Conclusion, Socio-economic deprivation was associated with lower rates of treatment and this partly explained variations in survival. Subjects who were referred to specialists were more likely to receive active treatment and treatment patterns varied between first trust attended. [source] Vascular endothelial growth factor reduces Fas-mediated acute liver injury in miceJOURNAL OF GASTROENTEROLOGY AND HEPATOLOGY, Issue 7pt2 2008Yoichi Tanaka Abstract Background and Aim:, Fulminant hepatitis is still a fatal liver disease, and no specific treatment for it has been available. Vascular endothelial growth factor (VEGF) is the focus of attention because of its various actions. We investigated the effect of vascular endothelial growth factor (VEGF) on Fas-induced fulminant hepatic failure (FHF). Method:, Male Balb/c mice were treated with an intraperitoneal injection of an anti-Fas antibody (Jo-2 Ab) with or without premedication with intraperitoneally administered human recombinant VEGF. Results:, The serum level of alanine aminotransferase (ALT) was up to 300 times higher that of normal mice following the Jo-2 Ab injection, and histological analysis revealed hepatic injury and massive hepatocyte apoptosis. The VEGF significantly suppressed an elevation in serum ALT levels and hepatocyte apoptosis. Immunohistochemically, VEGF-treated mice showed that Bcl-xL in hepatocytes was strongly expressed. Conclusions:, Since hepatocytes do not express VEGF receptors, we speculated that VEGF acts on sinusoidal endothelial cells (SECs) and promotes production of cytokines such as hepatocyte growth factor in SECs, resulting in reducing apoptosis through an increase expression of Bcl-xL in hepatocytes. We suggest that VEGF has a potent antiapoptotic effect on hepatocytes through cell,cell interaction between SECs and hepatocytes. [source] Spontaneous regression of hepatocellular carcinoma and review of literatureJOURNAL OF GASTROENTEROLOGY AND HEPATOLOGY, Issue 9 2000Yoshio Takeda Abstract A 68-year-old man presented with multiple hepatocellular carcinoma, which was considered to be unresectable at the first admission in January 1994. Pathological diagnosis was made by biopsy of the one lesion among them. From January 1994 to December 1997, 10 transarterial chemoembolizations and six percutaneous ethanol injection therapies were performed on the tumours in the cirrhotic liver. In February 1998 the tumour situated in the right lobe began to increase in size. The maximum tumour diameter was 6.3 cm measured by computed tomography (CT). In the beginning of May 1998 moderate ascites was present and mild hepatic encephalopathy was noticed. The patient was in the terminal stage of hepatocellular carcinoma and no further treatment was possible at that time. However, serum ,-fetoprotein and protein induced by vitamin K absence or antagonist II dramatically decreased in June 1998. The CT scan also showed that the tumour had completely regressed without specific treatment. In February 1999 a new biopsy-proven hepatocellular carcinoma, 2 cm in diameter, developed in the lateral segment of the liver. It was well treated by percutaneous ethanol injection therapy. The patient was alive in good condition without any symptoms or tumour recurrence in June 1999. It was concluded that a rare case of spontaneous regression of hepatocellular carcinoma had occurred. [source] Search for occult secondary osteoporosis: impact of identified possible risk factors on bone mineral densityJOURNAL OF INTERNAL MEDICINE, Issue 5 2002H. A. Deutschmann Abstract. Deutschmann HA, Weger M, Weger W, Kotanko P, Deutschmann MJ, Skrabal F (Krankenhaus der Barmherzigen Brüder, Marschallgasse, Teaching Hospital of the Karl-Franzens University Graz, Austria). Search for occult secondary osteoporosis: impact of identified possible risk factors on bone mineral density. J Intern Med 2002; 252: 389,397. Objectives. To determine whether the use of more elaborate diagnostic tests can identify possible risk factors for secondary osteoporosis and to evaluate the impact of these possible risk factors on the severity of bone disease in the study population. Design. Cross-sectional study. Setting and participants. ,We have investigated 377 subjects (285 females, 92 males) with osteoporosis (T-score less than ,2.5 in dual energy X-ray absorption) or nontraumatic lumbar vertebral fractures; these patients were referred to our hospital, a secondary care centre, for evaluation and treatment of osteoporosis. Results. Osteoporosis without attributable risk factor was diagnosed in 106 women (37%) and 30 men (33%). In 241 patients (179 women, 62 men) one or more possible risk factors for osteoporosis (in this paper also called subclinical disease) were revealed. The most common were lactose malabsorption, disturbed exocrine pancreatic function and renal tubular disturbances, including renal hypercalciuria, incomplete renal tubular acidosis and mild phosphate diabetes. The number of possible risk factors in the individual patient was significantly related to the severity of osteoporosis as assessed by Z-scores (Spearman correlation r = ,0.43, P < 0.001, n = 172 for females; r = ,0.28, P < 0.05, n = 65 for males). Conclusions. All the identified subclinical diseases would have remained undetected if the currently accepted guidelines for the investigation of patients with osteoporosis were applied. The statistically significant correlation between the number of identified possible risk factors and the severity of bone disease in the individual patient strongly suggests the pathogenetic significance of the identified subclinical diseases. It is yet to be shown, whether specific treatment of these subclinical diseases yields additional improvement of bone mass as compared with standard treatment of osteoporosis. [source] Association between anal furunculosis and colitis in the dog: preliminary observationsJOURNAL OF SMALL ANIMAL PRACTICE, Issue 3 2002P. M. Jamieson Treatment of anal furunculosis in dogs is often unsatisfactory and may be associated with significant recurrence and complications. This may be compounded by the simultaneous presence of colitis in affected animals. Clinical signs associated with colitis and anal furunculosis may be similar, including faecal tenesmus, dyschezia and haematochezia. To examine the incidence of concurrent anal furunculosis and colitis, colonic biopsies were collected from 18 dogs referred for treatment of anal furunculosis. Nine dogs (50 per cent) had a histopathological diagnosis of colitis. Clinical signs more indicative of colitis than anal furunculosis (increased frequency of defecation, mucus in faeces and diarrhoea) were not observed more frequently in dogs with confirmed colitis compared with those with furunculosis alone. Therefore, while an association between colitis and anal furunculosis may exist, clinical signs alone cannot be used as an indicator of the presence of colitis in cases of anal furunculosis. The authors recommend that colonic biopsies should be undertaken in all dogs presented with anal furunculosis. Whether specific treatment of colitis in dogs with histopathological evidence of colitis improves the outcome of treatment for anal furunculosis awaits further study. [source] Administration of 5% human serum albumin in critically ill small animal patients with hypoalbuminemia: 418 dogs and 170 cats (1994,2008)JOURNAL OF VETERINARY EMERGENCY AND CRITICAL CARE, Issue 2 2010Fabio Viganó DVM, SCMPA Abstract Objectives , To describe the administration of 5% human serum albumin (HSA) in 588 critically ill hypoalbuminemic dogs and cats, and report outcome to discharge, changes in albumin concentration, and adverse effects during hospitalization. Design , Retrospective clinical study. Setting , Private emergency and general veterinary center. Animals , Client-owned dogs and cats. Interventions , None. Measurements and Main Results , The medical records of 588 critically ill hypoalbuminemic animals (418 dogs and 170 cats) were reviewed. All animals had hypoalbuminemia (serum albumin <20 g/L [2.0 mg/dL]) at admission, received an infusion of 5% HSA, and received no other colloid infusion. The HSA solution was administered through a peripheral vein at 2 mL/kg/h for 10 h/d (total volume 20 mL/kg/d) until albumin reached 20 g/L. The number of days of HSA infusion (median and range) was 4 days (2,11 d) for dogs and 3 days (2,7 d) for cats. Three hundred and sixteen dogs (75.6%) survived to discharge; 56 of 418 (13.4%) died in hospital. One hundred and twenty-three cats (72.3%) survived to discharge; 21 of 170 (12.4%) died in hospital. Severe hypersensitivity reactions such as anaphylaxis, angioedema, and urticaria were not noted. Interruption of albumin infusion and specific treatment of reactions were not required in any animal. Conclusions , In this study, administration of 5% HSA appeared to be safe in a large group of critically ill, hypoalbuminemic dogs and cats. The results should be interpreted with caution due to the retrospective, descriptive nature of the study, the absence of control groups and the lack of follow-up data, as well as the potentially life-threatening complications of HSA administration. [source] Review article: the treatment of non-alcoholic steatohepatitis with thiazolidinedionesALIMENTARY PHARMACOLOGY & THERAPEUTICS, Issue 10 2005H. REYNAERT Summary It is generally accepted that non-alcoholic fatty liver disease will be the most frequent liver disease in the near future and that the management of patients with non-alcoholic fatty liver disease will be a challenge for hepatologists in the next decades. Non-alcoholic fatty liver disease is considered the hepatic manifestation of the metabolic syndrome, in which insulin resistance plays a crucial role. Although steatosis will often not progress to severe liver disease, in some patients, it results in cirrhosis and even hepatocellular carcinoma. Therefore, it is important to identify those patients at risk for developing fibrosis. Age, diabetes, obesity and hypertriglyceridaemia are independent risk factors for fibrosis in patients with elevated serum alanine aminotransferase levels and steatosis on ultrasound. The presence of multiple metabolic disorders increases the risk. Apart from diet, exercise and correction of underlying metabolic abnormalities, no specific treatment is available at the moment. Theoretically, thiazolidinediones are an attractive way to treat non-alcoholic fatty liver disease, because they improve insulin resistance. Some preliminary studies with thiazolidinediones were encouraging, as steatosis, inflammation and fibrosis improved in a substantial number of patients. Although no serious side effects occurred in the pilot studies, we should look vigilantly for hepatotoxicity, as the first generation thiazolidinediones proved to be toxic for the liver. [source] Treatment of chronic hepatitis E in liver transplant recipients with pegylated interferon alpha-2bLIVER TRANSPLANTATION, Issue 4 2010Elizabeth B. Haagsma Hepatitis E virus (HEV) infections are known to run a self-limiting course. Recently, chronic hepatitis E has been described in immunosuppressed patients after solid-organ transplantation. Besides the general recommendation to lower the immunosuppressive medication in these patients, there is currently no specific treatment. We here describe the successful use of pegylated interferon alpha-2b in the treatment of 2 liver transplant recipients who suffered a chronic HEV infection for 9 years (case A) or 9 months (case B). After 4 weeks of therapy, a 2-log decrease (case A) and a 3-log decrease (case B) in the viral load were observed. In case A, who received treatment for 1 year, serum viral RNA became undetectable from week 20 onward, and serum liver enzymes normalized completely. In case B, interferon was discontinued at week 16 because of a lack of a further decline in the viral load. However, 4 weeks after the cessation of therapy, viral RNA was no longer detectable in the serum, and this was probably related to a further decline in the immunosuppressive medication. Liver tests normalized completely. In both cases, no relapse has been noted so far. We conclude that pegylated interferon alpha-2b may be useful in the treatment of chronic HEV infections in patients in whom the reduction of the immunosuppressive medication alone is not sufficient. Liver Transpl , 2010. © 2010 AASLD. [source] Specific recommendations for PROs and HRQoL assessment in allergic rhinitis and/or asthma: a GA2LEN taskforce position paperALLERGY, Issue 8 2010F. Braido To cite this article: Braido F, Bousquet PJ, Brzoza Z, Canonica GW, Compalati E, Fiocchi A, Fokkens W, Gerth van Wijk R, La Grutta S, Lombardi C, Maurer M, Pinto AM, Ridolo E, Senna GE, Terreehorst I, Todo Bom A, Bousquet J, Zuberbier T, Baiardini I. Specific recommendations for PROs and HRQoL assessment in allergic rhinitis and/or asthma: a GA2LEN taskforce position paper. Allergy 2010; 65: 959,968. Abstract The GA2LEN taskforce on Patient-Reported Outcomes (PROs) and Health-Related Quality of Life (HRQoL) published in 2009 a position paper concerning PROS and HRQoL assessment in clinical trials on allergy. Because of the specificity of this topic in asthma and rhinitis, specific recommendations are needed. The aim of this position paper is to define PROs and their meaning in asthma and rhinitis research, explore the available tools to provide criteria for a proper choice, identify patient-related factor which could influence PROs assessment, define specific recommendations for assessment, analysis and results spreading, underline the unexplored areas and unmet needs. PROs assessment is gaining increasing importance, and it must be performed with a rigorous methodological procedure and using validated tools. This approach enables to better understand patient-related factors influencing clinical trials and real-life management outcomes, identify patients subgroups that can benefit from specific treatment and management plan and tailor treatment to address PROs (not only physician-defined targets) to improve asthma and rhinitis management. [source] Systemic and specific treatment for a global disease: allergen immunotherapy revisitedALLERGY, Issue 7 2006M. L. Kowalski First page of article [source] Paramethoxyamphetamine (PMA) poisoning; a ,party drug' with lethal effectsACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 10 2003S. Refstad Among young people in Norway the recreational use of amphetamine derivatives seems to be increasing. Methylenedioxymethamphetamine (MDMA), known as ecstasy, is the dominant substance, having both stimulant and psychedelic properties. Depending on the illegal source of these so-called ,party drugs' the content and purity can vary. This case report describes the first lethal case of paramethoxyamphetamine (PMA) and paramethoxymethamphetamine (PMMA) intoxication reported in Norway. A 16-year-old male was admitted to a local hospital in a coma with seizures and hyperthermia after he had been found undressed and barefooted in a local forest (temperature 2°C). He was intubated and given supportive care. Blood chemistry revealed hypoglycaemia, hypocalcaemia and hyperkalaemia. Shortly after transfer to the central hospital he developed bradycardia with continuous seizures and asystole. Adverse effects of MDMA are well described and include serotonergic and sympathomimetic symptoms with hyperthermia, coagulopathy, rhabdomyolysis and acute kidney and liver failure. Case reports of PMA deaths collectively suggest PMA to be more toxic than MDMA. A delayed effect after intake of PMA compared with MDMA can lead to increased intake. Hypoglycaemia and hyperkalaemia may be specific to PMA poisoning. Increased thermo genesis will result in a search for cooling, which explains the attempt to undress and a desire to submerge in water. In a cool climate this behaviour itself can be lethal. Measures to treat seizures, hypoglycaemia, electrolyte anomalies and hyperthermia are the therapeutic goals. No specific treatment is available. [source] | |||||||||||||||||||||||||||||||||||||