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Very Uncommon (very + uncommon)
Selected AbstractsFatal outcome from extreme acute gastric dilation after an eating bingeINTERNATIONAL JOURNAL OF EATING DISORDERS, Issue 7 2006Endre Gyurkovics MD Abstract Objective: A 22-year-old woman is presented with acute gastric dilation after an eating binge, who died of complications of acute reperfusion syndrome. Method: A young patient was admitted in our clinic with critical condition without any significant previous medical history. Her initial complaints , diarrhea, vomiting and abdominal pain , began after an enormous food intake. There was no history of medications or toxic substances. Physical examination showed a normally-developed, well-nourished female in severe distress with an extremely distended abdomen. Femoral pulses were absent. The US and CT scan showed a dilated stomach, extended into the pelvis, dislocating the intestinal organs and compressed the aorta and mesenteric veins. Results: Urgent laparotomy was performed. An enormously distended stomach was encountered without volvulus, obstruction or adhesions. About 11 liters of gastric content was removed gastrotomy and nasogastric tube. Following the gastric decompression, the mesenteric and femoral pulses reappeared. During the operation, the cardio-respiratory status was stabilized, but in the following 24 hours irreversible shock developed, possibly due to the reperfusion of the retroperitoneal organs and the lower extremities. In the postoperative period disseminated intravascular coagulopathy developed. In an uncontrollable state of diffuse bleeding, 36 hours post-operation, the patient died. In retrospective investigation, the family confessed that previous psychological treatments which aimed at her bulimic attacks. Conclusion: Acute gastric dilatation is very uncommon and is of various etiologies, two of these being anorexia nervosa and bulimia. Several cases documenting complications of gastric dilatation were published; however, such severe complications, involving gastric infarction and compression of the aorta with ischemic injury of the bowels and lower extremities, are rare. © 2006 by Wiley Periodicals, Inc. Int J Eat Disord 2006 [source] Sexually antagonistic coevolution in insects is associated with only limited morphological diversityJOURNAL OF EVOLUTIONARY BIOLOGY, Issue 3 2006W. Eberhard Abstract Morphological traits involved in male,female sexual interactions, such as male genitalia, often show rapid divergent evolution. This widespread evolutionary pattern could result from sustained sexually antagonistic coevolution, or from other types of selection such as female choice or selection for species isolation. I reviewed the extensive but under-utilized taxonomic literature on a selected subset of insects, in which male,female conflict has apparently resulted in antagonistic coevolution in males and females. I checked the sexual morphology of groups comprising 500,1000 species in six orders for three evolutionary trends predicted by the sexually antagonistic coevolution hypothesis: males with species-specific differences and elaborate morphology in structures that grasp or perforate females in sexual contexts; corresponding female structures with apparently coevolved species-specific morphology; and potentially defensive designs of female morphology. The expectation was that the predictions were especially likely to be fulfilled in these groups. A largely qualitative overview revealed several surprising patterns: sexually antagonistic coevolution is associated with frequent, relatively weak species-specific differences in males, but male designs are usually relatively simple and conservative (in contrast to the diverse and elaborate designs common in male structures specialized to contact and hold females in other species, and also in weapons such as horns and pincers used in intra-specific battles); coevolutionary divergence of females is not common; and defensive female divergence is very uncommon. No cases were found of female defensive devices that can be facultatively deployed. Coevolutionary morphological races may have occurred between males and females of some bugs with traumatic insemination, but apparently as a result of female attempts to control fertilization, rather than to reduce the physical damage and infections resulting from insertion of the male's hypodermic genitalia. In sum, the sexually antagonistic coevolution that probably occurs in these groups has generally not resulted in rapid, sustained evolutionary divergence in male and female external sexual morphology. Several limitations of this study, and directions for further analyses are discussed. [source] Case,control study of calcification of the hepatic artery in chronic hemodialysis patients: Comparison with the abdominal aorta and splenic arteryJOURNAL OF GASTROENTEROLOGY AND HEPATOLOGY, Issue 1 2002KUNIO OKUDA Abstract Background and Aims: Studies of the hepatic artery are scarce. We have observed that hepatic artery calcification is very uncommon in patients with hyperparathyroidism that expedites calcification. Methods: Plain abdominal CT was studied in 221 patients on chronic hemodialysis. Control consisted of 442 sex- and age-matched patients with other diseases. Calcification was graded as a percentage of the entire wall circumference for the aorta, and as a percentage of the entire length of the hepatic and splenic arteries from the celiac trunk to the hilum of each organ. Results: Aortic calcification was seen in 79.2% of male dialysis patients, 22.1% of controls, 74.1% of female dialysis patients and 17.3% of controls (P < 0.0001). Hepatic artery calcification was seen in only 13 dialysis patients. The degree of calcification of the abdominal aorta was correlated with the length of hemodialysis period (P = 0.008), but not with serum calcium, serum phosphate or their product. Although serum parathormone levels were not correlated with calcification, seven of eight dialysis patients with hepatic artery calcification had very high parathormone levels. Conclusions: The hepatic artery is far less frequently calcified than are the abdominal aorta and splenic artery. This may be a teleologic phenomenon of the liver. [source] Prevalence of gallstone disease in IranJOURNAL OF GASTROENTEROLOGY AND HEPATOLOGY, Issue 5 2001Sadegh Massarrat Abstract Background: Prevalence of gallstone disease is different depending on the geographic region involved. Few studies, in Asia but not from Iran, about the frequency of gallstone disease have been published. The aim of this study is to examine the prevalence of gallstone disease in Iran. Methods: Four hundred and seventy-seven nomads from southern Iran, 513 industrial laborers older than 34 years, and 421 laborers from a pharmaceutical company above 30 years of age, and 471 elderly persons from three nursing homes near Tehran underwent abdominal sonography. Results: There were 1373 men and 509 women. Eighty-nine subjects had gallstone disease and 10.1% of them were cholecystectomized. While the prevalence in the men and women in the age group 31,40 years was very low (0.3% in men and 1.8% in women), it increases sharply in men older than 60 years and women older than 50 years to more than 10-fold (12.5 and 24.6% in male and female with an age 71,80 years, respectively). Conclusion: In Iran, gallstone disease is very uncommon in middle-aged people, but increases sharply in older people. However, this does not reach the high prevalence seen in Western countries. The intake of a high fiber-containing diet, a low number of overweight people, smoking habit and hyperlipidemia are probably the cause for this low prevalence. [source] Atypical and malignant peripheral nerve-sheath tumors of the brachial plexus: Report of three cases and review of the literatureMICROSURGERY, Issue 2 2006Arvind Rawal M.S., F.R.C.S. Tumor involvement of the brachial plexus is uncommon. The most common intrinsic neoplasms involving the brachial plexus are benign neurilemmomas and neurofibromas that are usually associated with neurofibromatosis-1 (NF-1). Solitary neurofibromas unassociated with NF-1 are very uncommon. Malignant peripheral nerve-sheath tumors (MPNST) are rare at this site, arising spontaneously or in the context of NF-1. This presentation discusses the clinical presentation, pathology, and management of these tumors, which usually occur in young adults. MPNST are intermediate or high-grade sarcomas with a high risk of local and distant spread. Approximately 50% of MPNST arise in patients with NF-1, and therefore these patients should be thoroughly investigated for any new symptoms or masses. MPNST of the brachial plexus should be treated with an adequate wide local excision, with adjuvant high-dose radiotherapy pre- or postoperatively. The role of chemotherapy in the treatment of MPNST is not clearly defined, but it may have some benefit in salvaging treatment failures. © 2006 Wiley-Liss, Inc. Microsurgery 26: 80,86, 2006. [source] Original article: Atopy and asthma in rural Poland: a paradigm for the emergence of childhood respiratory allergies in EuropeALLERGY, Issue 4 2007B. Sozanska Background:, We hypothesized that, in south-west Poland, a ,rural' protective effect on atopy and respiratory allergies would be most pronounced among children but that at all ages would be stronger among those with a rural background. Methods:, A cross-sectional survey of the inhabitants (age >5 years, n = 1657) of Sobotka, a town of 4000 people in south-west Poland: and seven neighbouring villages. We measured and analysed responses to skin prick tests (atopy) and to a standard questionnaire (asthma and hayfever). Results:, Atopy was very uncommon (7%) among villagers at all ages but not among townspeople (20%, P < 0.001); the differences were most marked among those aged under 40 years. Asthma and hayfever were similarly distributed, both being very rare among villagers. The differences appear to be explained by the cohort effect of a communal move away from rural life. This interpretation is supported by an ecological correlation (, = ,0.59) between rural populations and childhood wheeze in 22 European countries. Conclusion:, The very striking differences in the prevalence of allergy between these two neighbouring communities of central Europe reflect the pan-continental population movements that may have been responsible for the emergence of childhood allergies in Europe. [source] Pleomorphic adenoma with extensive necrosis: report of two casesORAL DISEASES, Issue 1 2004YK Chen Pleomorphic adenoma (PA) is the most common neoplasm for both the major and minor salivary glands. While PA is occasionally associated with cystic change or hemorrhage necrosis, spontaneous infarction appears to be very uncommon. We report two unusual cases of extensive necrosis of PA; one occurred in the palate with the necrotic tumor mass slipping into the oral cavity. This phenomenon, possibly associated with incision biopsy, has never been described previously. A second case, arising in the parotid with spontaneous tumor necrosis, poses some dilemma in differential diagnosis. [source] Pediatric squamous cell carcinoma arising in an alpha-fetoprotein-producing mature cystic teratoma of the mandiblePEDIATRIC BLOOD & CANCER, Issue 1 2009Robert J. Cabay MD Abstract Teratomas, most often diagnosed in younger patients, represent the most frequently identified subtype of pediatric germ cell tumors. It is very uncommon for teratomas to present in the head and neck region and demonstrate malignant transformation. We present a case of squamous cell carcinoma arising in an alpha-fetoprotein-producing cystic teratoma of the mandible in a 2-year-old female that is, to the best of our knowledge, the first such published report. The patient was treated with surgical excision along with chemotherapy and has remained disease-free 2 years after the conclusion of therapy. Pediatr Blood Cancer 2009;52:130,132. © 2008 Wiley-Liss, Inc. [source] Salivary gland neoplasms in children: The experience of the Istituto Nazionale Tumori of MilanPEDIATRIC BLOOD & CANCER, Issue 6 2006Marco Guzzo MD Abstract Background Epithelial salivary gland tumors are very uncommon in pediatric age. We report a series of 52 cases treated at the Istituto Nazionale Tumori of Milan, Italy, over a 30-year period. These results are presented in conjunction with a literature review of salivary tumors with a view to providing an up-to-date overview of the clinical course, prognosis, and treatment options for this rare tumor. Procedure Fifty-two cases of epithelial salivary tumors were reviewed and the clinical-pathological information concerning tumor characteristics, therapy, and follow-up were collected. Patients' age ranged between 4 and 18 years. Results The major salivary glands were the main site of tumor occurrence (79% of cases arose in parotid glands); 37 patients had benign tumors (pleomorphic adenoma), 15 had malignant tumors (12 mucoepidermoid carcinoma, 9 low grade). All the patients were treated by surgery; local relapses after parotidectomy were 4% and 25%, in benign and malignant tumors, respectively. When tumor enucleation was performed, recurrences occurred in 50% of benign neoplasms. At the time of the report, all patients with benign tumors were alive, 35(95%) without evidence of disease; only one patient with malignant tumor died of disease. Conclusions Epithelial salivary glands tumor in children had different characteristics compared with their adult counterpart with respect to the frequency of histotypes and site of occurrence, but their prognosis seems to be similar. Parotidectomy (total or superficial) is the best choice for achieving good cure rates in both benign and malignant tumors. Pediatric Blood Cancer 2006;47:806,810. © 2006 Wiley-Liss, Inc. [source] Communicating breast cancer treatment complication risks: When words are likely to failASIA-PACIFIC JOURNAL OF CLINICAL ONCOLOGY, Issue 3 2009Peter H GRAHAM Abstract Aim: The aim of the present study was to describe women's preferences for the quantification of the risk of a serious complication after regional nodal radiotherapy for breast cancer and women's interpretation of a range of descriptive terms. Methods: A cross-sectional survey was conducted to elicit risk expression preferences and interpretation of words commonly used to describe the risk or frequency of a complication. Two hundred and sixty-two women who had experienced breast-only radiotherapy for early breast cancer at a Sydney teaching hospital were recruited for the survey. Results: The most preferred single method of expression of a risk is descriptive words, for example "uncommon" (52%), followed by percentages (27%) and numbers, for example 1 in 100 (21%). Lower education levels, more advanced cancer stage and older age increase the preference for descriptive words. When considering a serious complication of treatment, such as loss of the function of an arm, the modal interpretation of the descriptors "sometimes" was 1/100 (36% of women), "uncommon" was 1/1000 (35%), "very uncommon" was 1/10 000 (40%), "rare" was 1/10 000 (58%) and "very rare" was 1/10 000 (51%). However, the range of interpretations and the consistent assignment of extremely low frequencies of risk generally render descriptive words without numerical quantification inadequate for informed consent. Conclusion: Although risks of side-effects are often described in words such as common, uncommon and rare, qualification should be provided with numerical values to ensure better understanding of risk. [source] Mycosis fungoides and chronic lymphocytic leukaemia , composite T-cell and B-cell lymphomas presenting in the skinBRITISH JOURNAL OF DERMATOLOGY, Issue 2 2000P.R. Hull Composite lymphomas involving cutaneous B-cell and T-cell lymphomas are very uncommon. We report here the unique circumstance of a patient with mycosis fungoides (primary cutaneous T-cell lymphoma) who later developed chronic lymphocytic leukaemia (B-cell lymphoproliferation, B-CLL), which presented in the skin (leukaemia cutis) as a composite lymphoma affecting an earlobe. The presence of both lymphoproliferative disorders was confirmed with immunophenotyping and the finding of both immunoglobulin gene rearrangements and T-cell receptor gene rearrangements in the ear and the same T-cell receptor gene rearrangement in a plaque lesion of mycosis fungoides on the arm. [source] Acute retrobulbar optic neuropathy due to rupture of an anterior communicating artery aneurysmACTA OPHTHALMOLOGICA, Issue 1 2006Catherine Claes Abstract. Purpose:,The vast majority of ruptured aneurysms of the anterior communicating artery typically present with subarachnoid haemorrhage. Isolated visual complaints are very uncommon in this setting. We present an unusual case of a patient with an acute retrobulbar optic neuropathy, secondary to a ruptured anterior communicating artery aneurysm. Design:,Observational case report. Methods:,A 29-year-old woman was assessed for an acute, isolated unilateral optic neuropathy of unknown origin. Although an initial encephalic MRI was believed to be normal, an underlying ruptured anterior communicating artery aneurysm was eventually diagnosed when the patient became stuporous because of intracranial bleeding. Conclusions:,Occurrence of an acute retrobulbar optic neuropathy may be the initial isolated sign related to a ruptured anterior communicating artery aneurysm, prompting an appropriate neuroradiological assessment. [source] A case of fulminant post-transplant lymphoproliferative disorder and septicemiaCLINICAL TRANSPLANTATION, Issue 2 2006Ghazaleh Gouya Abstract: The fulminant form of post-transplant lymphoproliferative disorder (PTLD) is very uncommon and occurs in approximately 1% of PTLD patients. Approximately 85% of these lesions are of B-cell origin, and most of them are associated with Epstein,Barr virus infection. Fulminant PTLD is frequently associated with a systemic inflammatory response syndrome, and may be difficult to differentiate from septicemia. We describe the case of a 59-yr-old man who suffered from prolonged septicemia in the immediate post-transplant period, and presented again four months after cardiac transplantation with fever, painful liver edge and gastrointestinal bleeding. The diagnosis of fulminant PTLD with advanced multiorgan infiltration by a diffuse large-cell lymphoma of B-cell phenotype was made. During treatment with rituximab, the patient died from Enterococcus faecium septicemia. The sequence of septicemia, PTLD and, finally again, septicemia is an unusual challenge and urges for an aggressive diagnostic approach, where markers like procalcitonin may aid in the discrimination of fulminant PTLD from septicemia. [source] | ||||||||||