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Selected AbstractsEffect of weight-reducing agents on glycaemic parameters and progression to Type 2 diabetes: a reviewDIABETIC MEDICINE, Issue 10 2008C. Lloret-Linares Abstract Weight loss is associated with improvements in glycaemic control and cardiovascular disease risk factors. However, in the diabetic population, weight management is more challenging, in part because of the weight-promoting effects of the majority of glucose-lowering therapies. This review summarizes evidence from 23 placebo-controlled randomized trials, of at least 1 year duration, on the effects of drugs promoting weight loss (orlistat, sibutramine and rimonabant) on glycaemic variables, diabetes incidence and diabetes control. Fifteen studies of non-diabetic subjects were found, eight of which included a longer treatment period. Eight studies in diabetic patients were reviewed. In non-diabetic subjects, weight loss agents led to a significant improvement in fasting glucose, fasting insulin and insulin resistance. In the diabetic population, glycated haemoglobin decreased by 0.28,1.1% with orlistat and 0.6% with sibutramine and rimonabant. Orlistat reduces progression to diabetes in patients with glucose intolerance treated for 4 years (risk reduction of 45%). In summary, despite leading to only modest weight loss after 12 months, agents promoting weight loss have beneficial effects on glycaemic parameters, glycaemic control and progression to diabetes. These additional benefits of weight loss agents need to be highlighted in order to increase their judicious use in clinical practice, although this may be limited by their well-known adverse side effects. The longer-term safety of these agents beyond a few years is yet to be established. [source] Leg ulcers and hydroxyurea: report of three cases with essential thrombocythemiaINTERNATIONAL JOURNAL OF DERMATOLOGY, Issue 12 2002Zeynep Demirçay MD Case 1,A 65-year-old woman with essential thrombocythemia (ET) had been taking oral hydroxyurea (HU), 1000 mg daily, for 7 years. Six months ago, she developed an ulcer on the outer part of her left ankle, which healed spontaneously within 2 months. She presented with a new, tender, shallow ulcer, 2 cm × 2 cm in size, at the same site. Doppler examination revealed thrombosis of the left common femoral vein and a calcified atheroma plaque of the left common femoral artery. The dosage of HU was decreased to 500 mg daily when the platelet counts were found to be within normal levels. The ulcer completely healed within 2 months with occlusive wound dressings, and has not recurred within the follow-up period of 1 year. Case 2,A 56-year-old women presented with multiple, painful, leg ulcers of 1 year duration. She had been diagnosed as having ET and had been on HU therapy, 1500 mg/day, for the past 5 years. Interferon-,-2b was started 3 months ago, in addition to HU, which was tapered to 1000 mg daily. She had suffered from hypertension for 20 years treated with nifedipine and enalapril, and had recently been diagnosed with diabetes mellitus which was controlled by diet. Examination revealed three ulcers located on the lateral aspects of both ankles and right distal toe. Arterial and venous Doppler examinations were within normal limits. Histopathology of the ulcer revealed nonspecific changes with a mixed inflammatory cell infiltrate around dermal vessels. The ulcers completely healed within 10 weeks with topical hydrocolloid dressings. After healing, she was lost to follow-up. A year later, it was learned that she had developed a new ulcer at her right heel, 3 months after her last visit (by phone call). This ulcer persisted for 8 months until HU was withdrawn. Case 3,A 64-year-old woman with ET presented with a painful leg ulcer of 6 months' duration. She had been taking oral HU for 5 years. She had a 20-year history of hypertension treated with lisinopril. Examination revealed a punched-out ulcer of 2 cm × 2 cm over the right lateral malleolus (Fig. 1). Doppler examination of the veins revealed insufficiency of the right greater saphenous and femoral veins. Angiography showed multiple stenoses of the right popliteal and femoral arteries. As her platelet count remained high, HU was continued. During the follow-up period of 13 months, the ulcer showed only partial improvement with local wound care. Figure 1. Punched-out ulcer surrounded by an erythematous border over the right malleolus (Case 3) [source] Symptoms of gastro-oesophageal reflux: prevalence, severity, duration and associated factors in a Spanish populationALIMENTARY PHARMACOLOGY & THERAPEUTICS, Issue 1 2004M. Diaz-Rubio Summary Aim :,To measure the prevalence of gastro-oesophageal reflux symptoms and to identify associated factors in a representative sample of the Spanish population. Methods :,A telephone survey of 2500 subjects was performed using a validated questionnaire. The association of gastro-oesophageal reflux symptoms (defined as the presence of heartburn or acid regurgitation) and their clinical characteristics with potential risk factors was summarized using the odds ratios (OR) obtained by multiple logistic regression. Results :,The response rate was 71.2%. The annual prevalence of gastro-oesophageal reflux symptoms was 31.6%[95% confidence interval (CI), 29.8,33.4] and the weekly prevalence was 9.8% (95% CI, 8.6,10.9). Gastro-oesophageal reflux symptoms were associated with excess weight (OR, 1.53; 95% CI, 1.23,1.92), obesity (OR, 1.74; 95% CI, 1.30,2.32), the psychosomatic symptom score (OR, 2.98; 95% CI, 2.41,3.67) and the presence of gastro-oesophageal reflux symptoms in a direct family member (OR, 1.61; 95% CI, 1.17,2.23). Gastro-oesophageal reflux symptoms of ,,10 years' duration were more frequent in obese subjects (OR, 1.92; 95% CI, 1.14,3.22) and those with a direct family member with gastro-oesophageal reflux symptoms (OR, 2.42; 95% CI, 1.44,4.06). Factors associated with gastro-oesophageal reflux symptoms of ,,1 year duration were a spouse with gastro-oesophageal reflux symptoms (OR, 2.33; 95% CI, 1.39,3.9) and the consumption of 1,5 aspirins/week (OR, 1.70; 95% CI, 1.01,2.86). Conclusions :,The prevalence of frequent gastro-oesophageal reflux symptoms in Spain is lower than that observed in other Western populations. The psychosomatic symptom score is the factor most strongly associated with gastro-oesophageal reflux symptoms. Long-term gastro-oesophageal reflux symptoms are associated with certain genetic factors (obesity, family history of gastro-oesophageal reflux symptoms), whereas short-term gastro-oesophageal reflux symptoms are associated with factors of probable environmental nature. [source] Healing of Venous Ulcers of Long Duration with a Bilayered Living Skin Substitute: Results from a General Surgery and Dermatology DepartmentDERMATOLOGIC SURGERY, Issue 11 2001Harold Brem MD Background. A laboratory-grown bilayered living skin substitute (LSS) has been shown to accelerate the healing of venous ulcers. However, issues related to optimal wound bed preparation prior to the application of LSS have not been addressed. Objective. When combined with standard compression therapy and near elimination of wound exudate, bioengineered skin can achieve complete closure of venous ulcers which have been present for more than a year and which are difficult to heal. Methods. In the general surgery (center A) and dermatology (center B) departments at two separate medical centers, LSS was used to treat venous ulcers of more than 1 year's duration and which had been unresponsive to conventional therapy. Wound bed preparation at both centers had as common goals the removal of necrotic tissue, optimal formation of granulation tissue, and elimination of wound exudate. Results. There was great comparability between the two centers in the patients being treated, wound size and duration, and number of LSS applications. Both centers achieved a frequency of complete wound closure of greater than 70% within 6 months. Conclusion. At two separate clinical and specialty sites having a common goal of optimal wound preparation, treatment with LSS was associated with a high rate of complete closure of hard to heal venous ulcers. [source] The impact of psychological factors on placebo responses in a randomized controlled trial comparing sham device to dummy pillJOURNAL OF EVALUATION IN CLINICAL PRACTICE, Issue 1 2009Suzanne M. Bertisch MD MPH Abstract Objectives, To explore to what extent psychological factors such as expectation, depression, anxiety and belief in alternative medicine impact placebo response and differential responses to separate placebo interventions. Methods, We analysed data from a randomized controlled trial designed to compare the clinical response of two distinct placebo treatments (sham acupuncture device and placebo pill) in 119 participants with persistent distal upper arm pain due to repetitive stress injury. We used a multivariable linear regression model to identify potential correlates of self-reported upper extremity pain at the end of treatment in both placebo arms of the study combined. We also performed stratified analyses by placebo treatment. Results, We did not find any of the psychological factors of interest to be associated with pain at the end of treatment in our combined analysis. We found higher baseline pain score and pain for longer than 1 year's duration to be significantly associated with higher pain scores at the end of treatment for the placebo treatments combined. In stratified analyses, for the sham acupuncture group, we found higher baseline depression score, higher baseline pain score and younger age to be independently correlated with higher pain score at the end of treatment. For the placebo pill group, only baseline pain was significantly correlated to pain score at the end of treatment. Conclusion, In this trial, neither expectancy nor psychological states were associated with response to placebo, with the exception of baseline depression score for the sham acupuncture arm. [source] Subungual Schwannoma: A Rare LocationDERMATOLOGIC SURGERY, Issue 5 2005Sang Eun Moon MD background. Schwannoma is a benign tumor of neural tissue and usually develops in deeper soft tissue. Cutaneous involvement is uncommon, and a subungual location is extremely rare. In fact, it has not been previously reported. objective. To present a case of subungual schwannoma. method. A 49-year-old man had a subungual tumor on his right thumb of 8 years duration. The lesion caused a mild stinging sensation in winter and grew slowly. The tumor was excised using a transungual approach. After closure, the wound was dressed with a trimmed original nail plate. results. The nail plate grew normally, and there was no recurrence 1 year postoperatively. conclusion. We describe a case of schwannoma that developed in the subungual area of a thumb. Although schwannoma rarely develops in this area, it should be considered in the differential diagnosis of subungual tumor. [source] Initial short-term intensive insulin therapy as a strategy for evaluating the preservation of beta-cell function with oral antidiabetic medications: a pilot study with sitagliptinDIABETES OBESITY & METABOLISM, Issue 10 2010R. Retnakaran Aim: Studies evaluating the effects of oral antidiabetic drugs (OADs) on beta-cell function in type 2 diabetes mellitus (T2DM) are confounded by an inability to establish the actual baseline degree of beta-cell dysfunction, independent of the deleterious effects of hyperglycaemia (glucotoxicity). Because intensive insulin therapy (IIT) can induce normoglycaemia, we reasoned that short-term IIT could enable evaluation of the beta-cell protective capacity of OADs, free from confounding hyperglycaemia. We applied this strategy to assess the effect of sitagliptin on beta-cell function. Methods: In this pilot study, 37 patients with T2DM of 6.0 + 6.4 years duration and A1c 7.0 + 0.8% on 0,2 OADs were switched to 4,8 weeks of IIT consisting of basal detemir and premeal insulin aspart. Subjects achieving fasting glucose <7.0 mmol/l 1 day after completing IIT (n = 21) were then randomized to metformin with either sitagliptin (n = 10) or placebo (n = 11). Subjects were followed for 48 weeks, with serial assessment of beta-cell function [ratio of AUCCpep to AUCgluc over Homeostasis Model Assessment of Insulin Resistance (HOMA-IR) (AUCCpep/gluc/HOMA-IR)] on 4-h meal tests. Results: During the study, fasting glucagon-like-peptide-1 was higher (p = 0.003) and A1c lower in the sitagliptin arm (p = 0.016). Nevertheless, although beta-cell function improved during the IIT phase, it declined similarly in both arms over time (p = 0.61). By study end, AUCCpep/gluc/HOMA-IR was not significantly different between the placebo and sitagliptin arms (median 71.2 vs 80.4; p = 0.36). Conclusions: Pretreatment IIT can provide a useful strategy for evaluating the beta-cell protective capacity of diabetes interventions. In this pilot study, improved A1c with sitagliptin could not be attributed to a significant effect on preservation of beta-cell function. [source] A comparison of clinical and psychological features in subgroups of patients with anorexia nervosaEUROPEAN EATING DISORDERS REVIEW, Issue 4 2003Manuela Oliosi Abstract Background: In DSM-IV anorexics who purge without binging (AN-P) are considered together with the binge eating purging subgroup (AN-B). Few studies have investigated whether it is binge eating per se or the compensatory behaviours that provide the most relevant marker for subclassifying anorexia nervosa. Methods: We compared 40 restricting-type anorexics (AN-R), 40 AN-B and 38 AN-P subjects consecutively admitted to our inpatient treatment. We excluded patients who had not had a diagnosis of anorexia nervosa for at least 1.5 years duration. Results: AN-B patients showed a slightly more severe eating disorder symptomatology, while in terms of body weight AN-R and AN-P present a higher degree of weight loss. Psychiatric symptoms were similar in the three groups. Sexual abuse, suicide attempts and dissociative symptoms were higher in AN-P and AN-B patients compared to AN-R. Discussion: Our results together with the fact that it is difficult to define binge eating in anorexic subjects and that purging behaviours are often associated with severe medical complications, support the subtyping system of anorexia nervosa based on the presence/absence of purging behaviours rather than of binge eating. Copyright İ 2003 John Wiley & Sons, Ltd and Eating Disorders Association. [source] The academic environment: the students' perspectiveEUROPEAN JOURNAL OF DENTAL EDUCATION, Issue 2008K. Divaris (nci) Abstract Dental education is regarded as a complex, demanding and often stressful pedagogical procedure. Undergraduates, while enrolled in programmes of 4,6 years duration, are required to attain a unique and diverse collection of competences. Despite the major differences in educational systems, philosophies, methods and resources available worldwide, dental students' views regarding their education appear to be relatively convergent. This paper summarizes dental students' standpoint of their studies, showcases their experiences in different educational settings and discusses the characteristics of a positive academic environment. It is a consensus opinion that the ,students' perspective' should be taken into consideration in all discussions and decisions regarding dental education. Moreover, it is suggested that the set of recommendations proposed can improve students' quality of life and well-being, enhance their total educational experience and positively influence their future careers as oral health physicians. The ,ideal' academic environment may be defined as one that best prepares students for their future professional life and contributes towards their personal development, psychosomatic and social well-being. A number of diverse factors significantly influence the way students perceive and experience their education. These range from ,class size', ,leisure time' and ,assessment procedures' to ,relations with peers and faculty', ,ethical climate' and ,extra-curricular opportunities'. Research has revealed that stress symptoms, including psychological and psychosomatic manifestations, are prevalent among dental students. Apparently some stressors are inherent in dental studies. Nevertheless, suggested strategies and preventive interventions can reduce or eliminate many sources of stress and appropriate support services should be readily available. A key point for the Working Group has been the discrimination between ,teaching' and ,learning'. It is suggested that the educational content should be made available to students through a variety of methods, because individual learning styles and preferences vary considerably. Regardless of the educational philosophy adopted, students should be placed at the centre of the process. Moreover, it is critical that they are encouraged to take responsibility for their own learning. Other improvements suggested include increased formative assessment and self-assessment opportunities, reflective portfolios, collaborative learning, familiarization with and increased implementation of information and communication technology applications, early clinical exposure, greater emphasis on qualitative criteria in clinical education, community placements, and other extracurricular experiences such as international exchanges and awareness of minority and global health issues. The establishment of a global network in dental education is firmly supported but to be effective it will need active student representation and involvement. [source] Australian drought: the interference of multi-spectral global standing modes and travelling wavesINTERNATIONAL JOURNAL OF CLIMATOLOGY, Issue 6 2003Warren B. White Abstract Extreme drought has devastated the flora, fauna, and regional economy in rangeland grazing districts over Australia for 3,5 years duration every 20 to 30 years throughout the 20th century. We investigate the source of drought occurring in five example grazing districts in eastern and central Australia. We find year-to-year variability in grazing district rainfall (GDR) during the summer rainy season (November to March) composed of quasi-biennial, interannual, quasi-decadal, and interdecadal signals from 1900 to 1999. However, the longer period signals dominate, accounting for the interdecadal quasi-periodicity of the drought/flood cycle. We find these GDR signals associated with corresponding global standing modes and travelling waves in covarying sea-surface temperature (SST) and sea-level pressure (SLP) anomalies. These global SST/SLP modes/waves influence the GDR signals by altering the troposphere moisture flux converging onto the grazing districts from regional tropical and extra-tropical oceanic source regions. We construct statistical models to determine whether the evolution of these global SST/SLP modes/waves over the oceanic source regions can hindcast corresponding GDR signals from one year to the next. When these models allow for modulation of the modes/waves, they hindcast ,1/3 of the variance in the GDR indices at 1 year lead, including the drought episodes. We find drought resulting from the constructive interference of the dry phases of the quasi-decadal and interdecadal global SST/SLP modes/waves, accompanied by a weakening of year-to-year variability associated with either weak quasi-biennial and interannual modes/waves or their destructive interference. Copyright İ 2003 Royal Meteorological Society [source] Predictors of coronary heart disease in Japanese patients with type 2 diabetes: Screening for coronary artery stenosis using multidetector computed tomographyJOURNAL OF DIABETES INVESTIGATION, Issue 1-2 2010Hiroko Nishioka Abstract Aims/Introduction:, Multidetector computed tomography (MDCT) coronary angiography has been applied as a tool for non-invasive evaluation of the coronary arteries. The purpose of the present study was to evaluate the effectiveness of MDCT in screening for coronary artery disease (CAD), and to identify the indications for screening in diabetes patients with CAD. Materials and Methods:, The study population consisted of 52 Japanese type 2 diabetes patients who underwent examination with a 64-slice MDCT scanner, electrocardiogram (ECG), echocardiography and ultrasonographic scanning of the carotid arteries. Regression analysis was carried out to assess the correlation between MDCT results and CAD risk factors. Results:, Stenosis of the coronary artery was detected in 19/52 patients. Of the 19 patients, 7 patients had no symptoms, including chest pain, and no ischemic changes in ECG. Significant differences between patients with stenosis and those without stenosis were detected by mean IMT (1.21 vs 0.95 mm), and duration of diabetes (20 vs 13 years). Two-tailed ,2 -test showed that a duration of diabetes of more than 20 years (odds ratio 6.222) and more than 1.1 mm of mean-IMT (odds ratio 4.600) significantly correlated with the stenosis. Conclusions:, It was shown that MDCT is useful in detecting coronary artery stenosis in diabetic patients without symptoms of CAD or ECG abnormality, and the predictors of CAD are mean IMT and duration of diabetes. It is recommended that patients with more than 1.1 mm mean IMT at the carotid artery and/or more than 20 years duration of diabetes should be screened for CAD by carrying out MDCT. [source] A very large Schwannoma originating from the median nerve in carpal tunnelJOURNAL OF THE PERIPHERAL NERVOUS SYSTEM, Issue 3 2004Hakan Gündes Abstract Schwannomas are common benign nerve tumors occurring in the peripheral nerves. A very large schwannoma of more than 5 years duration, originating from the median nerve in the carpal tunnel in a 38-year-old woman, is reported. There was a painful mass, 60 mm in length and 42 mm in diameter, on the palm without signs of sensory disturbance or atrophy on the thenar muscles. Surgical removal was performed under high-power magnification by separating the sensory and motor fascicles from the tumor. Histological examination resulted in a Schwannoma. At 4-year follow-up, the patient was asymptomatic with excellent relief of symptoms. The tumor did not recur. Although cases have been reported in the literature, this is one of the largest ever described without any neurologic deficit. [source] The prevalence, clinical features and association of HLA-B27 in sacroiliitis associated with established Crohn's diseaseALIMENTARY PHARMACOLOGY & THERAPEUTICS, Issue 2 2009T. R. ORCHARD Summary Background Sacroiliitis is a recognized complication of Crohn's disease and may occur distinct from progressive ankylosing spondylitis (AS). Aim To estimate prospectively the prevalence of sacroiliitis in patients with established Crohn's disease, to characterize the clinical features and to correlate these with the presence of HLA-B27. Methods All Crohn's disease patients under active follow-up of between 5 and 12 years duration were invited to participate. Patients underwent a clinical evaluation including symptom questionnaire, rheumatological examination and underwent HLA genotyping. Patients then underwent magnetic resonance imaging (MRI) of the sacroiliac joints. The clinical and radiological factors were correlated with HLA-B27 status. Results 56 patients underwent initial assessment and 44 had MRI scans. Seventeen of 44 (39%) patients had MRI evidence of sacroiliitis, of whom 5 fulfilled the criteria for AS. Symptoms of low back pain were elicited in a majority of these patients , 11/17 (65%) compared to 3 of 27 (11%) patients with normal scans (P = 0.003). There were no differences in functional indices with the exception of patients with AS. HLA-B27 was present in seven patients, and all seven had MRI evidence of sacroiliitis, five had AS. Conclusions Sacroiliitis is common in patients with established Crohn's disease and in the majority of cases, patients have symptoms of inflammatory low back pain if questioned carefully. HLA-B27 is not associated with isolated sacroiliitis, but is associated with AS. However, possession of HLA-B27 appears to convey a very high risk of developing axial inflammation in Crohn's disease. [source] Agreement of efficacy assessments for five-grass pollen sublingual tablet immunotherapyALLERGY, Issue 1 2009A. Didier Background:, The optimal dose of five-grass pollen sublingual tablet immunotherapy (SLIT) was established recently by the primary criteria Rhinoconjunctivitis Total Symptom Score (RTSS) from the first treatment season. Secondary and exploratory criteria, such as RTSS at peak pollen season, exploratory combined symptom and rescue medication use score, quality of life and immunological markers are calculated and described in this analysis. Methods:, Six hundred and twenty-eight patients with grass pollen rhinoconjunctivitis (,2 years duration) were randomized in a double-blind, placebo-controlled trial conducted in Europe. Patients received once-daily SLIT (Stallergenes, Antony, France) of 100IR, 300IR, 500IR or placebo, starting 4 months before grass pollen season and throughout the 2005 season. Patients were instructed to take rescue medication only if symptoms were severe and record symptom severity on using the RTSS. Results:, Both 300IR and 500IR doses significantly reduced mean RTSS at pollen peak (P = 0.0005 and P = 0.0014, respectively) and the exploratory combined score (P = 0.0001 and P = 0.0026, respectively) compared with placebo. Compared with patients in the placebo group, those who were taking the 300IR and 500IR doses reported significantly improved quality of life using the mean Rhinoconjunctivitis Quality of Life Questionnaire scores during the peak of the pollen season (P < 0.0001) and at the end of the pollen season (P = 0.0031 and P , 0.0001, respectively). Specific immunoglobulin G4 increased significantly depending on the SLIT dose (P < 0.0001). Conclusions:, All secondary efficacy criteria, including efficacy at pollen peak, combined score, quality of life and immunological changes, indicate that 300IR tablets represent the optimal dose and suggest it is appropriate for use in clinical practice. [source] Pinealoblastoma with prominent retinoblastic differentiation: An unusual case in an adultNEUROPATHOLOGY, Issue 4 2010Nandita Ghosal We present an extremely rare case of pinealoblastoma with retinoblastic differentiation in a 32-year-old woman who presented with a history of intermittent headache of 2 years duration and diminution of vision for 2 months which eventually lead to total loss of vision. The fundus examination showed bilateral secondary optic atrophy. She did not have any previous history of retinoblastoma. The family history was non-contributory. Paraffin section of the tumor showed a primitive neuroectodermal tumor with numerous Flexner-Wintersteiner rosettes and the tumor cells were strongly positive for synaptophysin and negative for GFAP, S-100 protein and epithelial membrane antigen. This is the first case in the literature of a sporadic case of pinealoblastoma with prominent retinoblastic differentiation as evidenced histomorphologically by the presence of numerous Flexner-Wintersteiner rosettes in an adult female. [source] Multinucleated astrocytes in old demyelinated plaques in a patient with multiple sclerosisNEUROPATHOLOGY, Issue 3 2004Makoto Nishie A 51-year-old woman with MS of 26 years duration is reported. The patient's MS history began at the age of 25 years with an initial relapsing-remitting course, followed by slow progression without distinct relapses. She became bed-ridden at the age of 40 years. A post-mortem examination revealed numerous demyelinated plaques that exhibited fibrillary gliosis with Rosenthal fibers, but without lymphocytic cuffing or foamy macrophages. Activated microglia were found mainly in the marginal portion of the plaques. These plaques were consistent with so-called ,slowly expanding plaques'. Interestingly, multinucleated astrocytes were observed within the plaques, being more numerous in the area where microglial infiltration had occurred. These findings suggest that mild persistent inflammatory processes are present even in old plaques and that certain inflammatory stimuli cause multinucleation of astrocytes. This might explain the gradual deterioration without definite relapses observed in the late stage of MS. [source] Delayed Onset of Brown,Sequard Syndrome Involving Upper Extremity PainPAIN PRACTICE, Issue 2 2009Nelson Tang MD Abstract Report of a case: A 60-year-old white male with a history of C3,C4 spinal cord injury with subsequent C3,C4 fusion complained of right upper extremity painful spasms of 2 years duration with associated hyperspasticity, motor weakness and poor positional and vibrational sense. The patient was diagnosed with Brown,Sequard syndrome (BSS) and treated with botulinum toxin type A injections distributed into the affected muscle groups that provided substantial and lasting relief. This case is unique in that the patient's trauma occurred 28 years before the development of the BSS suggesting a slow evolution of the condition. [source] Rapamycin versus methotrexate in early diffuse systemic sclerosis: Results from a randomized, single-blind pilot studyARTHRITIS & RHEUMATISM, Issue 12 2009Tien-I Karleen Su Objective To assess the safety and efficacy of rapamycin in the treatment of diffuse systemic sclerosis (SSc; scleroderma). Methods Eighteen patients with diffuse SSc of ,5 years duration were randomized to receive rapamycin or methotrexate (MTX) in a single-blind, 48-week study. Abnormalities in clinical and laboratory parameters were compared between the 2 treatment groups. The potential efficacy of the study drugs was evaluated by comparing results of the baseline and 48-week assessments, including the modified Rodnan skin thickness score (MRSS) and the Health Assessment Questionnaire disability index. Results The baseline characteristics of the patients were similar in both groups (n = 9 in each). One patient in the rapamycin group who never received the study drug was excluded from the analysis. Three patients in each group withdrew from the study; 2 of the withdrawals were treatment-related (severe hypertriglyceridemia associated with rapamycin, and pancytopenia associated with MTX), and 4 were SSc-related. Hypertriglyceridemia was the most notable side effect associated with rapamycin, but it was generally well tolerated and treatable. The incidence and severity of other adverse drug reactions were comparable between the 2 groups. Within each group, the MRSS improved significantly from baseline. In the rapamycin group, the patient's global assessment showed a significant improvement from baseline, while forced vital capacity values declined from baseline. The disease activity scores at 48 weeks and the changes in these scores from baseline were not significantly different between the 2 groups. Conclusion Rapamycin has a reasonable safety profile in a select group of patients with scleroderma. Larger trials are needed to assess the efficacy of rapamycin in patients with early diffuse SSc. [source] Recurrent colics in a 9-year-old Arabian stallion due to several congenital anomaliesEQUINE VETERINARY EDUCATION, Issue 11 2008M. P. Robert Summary A 9-year-old Arabian stallion was presented for evaluation of recurrent colic problems of 2 years' duration. These colic episodes were associated with a right sided abdominal distension. An exploratory laparotomy revealed a colonic diverticulum that was resected en bloc. Two days later, following signs of acute colic, a second laparotomy showed incarceration of the distal jejunum into a mesodiverticular band combined with haemorrhage of a mesenteric arterial branch. In addition, an abnormally short jejunum (10 m) was also observed. An end-to-end jejunojejunostomy was performed. Following surgery the horse developed septic peritonitis, ptyalism and became dysphagic. Ten days after the second surgery, an infected oesophageal diverticulum causing regional inflammation was diagnosed endoscopically and euthanasia was performed. Post mortem examination showed a 40 cm long diverticulum lateral to the oesophagus. Histology suggested a congenital nature of the colonic and oesophageal diverticuli. [source] Endoscopic CO2 laser surgery for an atypical carcinoid tumor of the epiglottis masquerading as a supraglottic cyst,HEAD & NECK: JOURNAL FOR THE SCIENCES & SPECIALTIES OF THE HEAD AND NECK, Issue 11 2005Kai-Ping Chang MD Abstract Background. Atypical carcinoid tumor is a neuroendocrine tumor; its occurrence in the larynx is uncommon, and clinical manifestations are rare. We report an unusual case of atypical carcinoid tumor of the epiglottis mimicking a supraglottic retention cyst. Methods. A 44-year-old woman complained of an intermittent globus sensation of the throat of 2 years' duration. A 1.0- × 0.8-cm cystic lesion was found over the tip of the epiglottis. A supraglottic retention cyst was initially diagnosed, and the patient was treated medically. Her symptoms persisted, so we performed a laryngoscopic biopsy, which suggested an atypical carcinoid tumor. Results. Transoral endoscopic CO2 laser surgery and bilateral elective neck dissection were subsequently performed. The 2-year follow-up did not reveal any locoregional recurrence or distant metastasis. Conclusions. This aggressive neoplasm may cause only a few, unremarkable symptoms and masquerade as a supraglottic cyst. Endoscopic CO2 laser surgery can be used to resect this uncommon tumor, with oncologically sound results and without surgical morbidity. İ 2005 Wiley Periodicals, Inc. Head Neck27: XXX,XXX, 2005 [source] Treatment of dermal and subcutaneous pheohyphomycosis of 55 years' durationINTERNATIONAL JOURNAL OF DERMATOLOGY, Issue 5 2008J. Pec Prof. First page of article [source] Finger pebbles in a diabetic patient: Huntley's papulesINTERNATIONAL JOURNAL OF DERMATOLOGY, Issue 9 2005Claudio Guarneri MD A 60-year-old obese man was referred to our department from the internal medicine unit. He had a 20-year history of poorly controlled diabetes (no other cases in the family), and was admitted to hospital because of respiratory and consequent heart failure. Skin examination showed diffuse xerosis and a rough, sandpaper-like appearance of the skin of the finger, of approximately 15 years' duration, consisting of multiple, minute, hyperkeratotic papules grouped in a miniature "cobblestone" pattern on the dorsum of the distal phalanges (Fig. 1), more dense over the knuckles and the interphalangeal joints. No pruritus was present. Figure 1. Pebbly pattern of the skin on the dorsum of the second digit He was a pensioner, who had been physically inactive for months previously, and this condition had occurred progressively in the absence of any known trauma. No other cutaneous manifestations were evident. Histologic examination was performed using hematoxylin and eosin staining of a biopsy specimen taken from the left second finger; it displayed a hyperorthokeratotic epidermis with enlarged dermal papillae, thickened and vertically oriented collagen bundles, few elastic fibers, and a mild perivascular inflammatory infiltrate (Fig. 2). Figure 2. Histologic view of a biopsy specimen of the skin of the finger: the epidermis is hyperkeratotic, the dermal papillae are enlarged and there are thickened vertical collagen bundles, elastic fibers, and a mild perivascular inflammatory infiltrate (hematoxylin and eosin stain; original magnification, ×100) [source] Eccrine poroma of the heelINTERNATIONAL JOURNAL OF DERMATOLOGY, Issue 6 2000Harvey Lemont A 67-year-old African,American woman had a tender red nodule on the posterior aspect of her left heel of 20 years' duration. The lesion had initially grown quickly to its present size, but subsequently remained unchanged through the years. No previous history of trauma to the area could be elicited. The lesion was not tender or painful, although the patient related some recent discomfort when wearing shoes with high heel counters. Examination revealed a soft, multilobulated, skin-colored nodule, measuring approximately 1.1 cm at its greatest diameter ( Fig. 1), with a rim space or moat ( Fig. 2) surrounding the lesion. Biopsy of the lesion demonstrated a uniform proliferation of basaloid cells exhibiting a sharp demarcation between the adjacent normal epidermis ( Fig. 3). No horn cysts were present. The papillary dermis demonstrated multiple ectatic blood vessels ( Fig. 4) which may be responsible for its reddish appearance. Figure 1 Multilobulated,. red, granulating lesion on the posterior heel Figure 2 Note. the characteristic ,,moat'' surrounding the lesion Figure 3 Biopsy. reveals a proliferation of uniformly small cuboidal cells sharply demarcated from the adjacent normal epidermal cells Figure 4 Ectatic. vessel dilatation most likely responsible for the reddish color of the lesion [source] Symptoms of gastro-oesophageal reflux: prevalence, severity, duration and associated factors in a Spanish populationALIMENTARY PHARMACOLOGY & THERAPEUTICS, Issue 1 2004M. Diaz-Rubio Summary Aim :,To measure the prevalence of gastro-oesophageal reflux symptoms and to identify associated factors in a representative sample of the Spanish population. Methods :,A telephone survey of 2500 subjects was performed using a validated questionnaire. The association of gastro-oesophageal reflux symptoms (defined as the presence of heartburn or acid regurgitation) and their clinical characteristics with potential risk factors was summarized using the odds ratios (OR) obtained by multiple logistic regression. Results :,The response rate was 71.2%. The annual prevalence of gastro-oesophageal reflux symptoms was 31.6%[95% confidence interval (CI), 29.8,33.4] and the weekly prevalence was 9.8% (95% CI, 8.6,10.9). Gastro-oesophageal reflux symptoms were associated with excess weight (OR, 1.53; 95% CI, 1.23,1.92), obesity (OR, 1.74; 95% CI, 1.30,2.32), the psychosomatic symptom score (OR, 2.98; 95% CI, 2.41,3.67) and the presence of gastro-oesophageal reflux symptoms in a direct family member (OR, 1.61; 95% CI, 1.17,2.23). Gastro-oesophageal reflux symptoms of ,,10 years' duration were more frequent in obese subjects (OR, 1.92; 95% CI, 1.14,3.22) and those with a direct family member with gastro-oesophageal reflux symptoms (OR, 2.42; 95% CI, 1.44,4.06). Factors associated with gastro-oesophageal reflux symptoms of ,,1 year duration were a spouse with gastro-oesophageal reflux symptoms (OR, 2.33; 95% CI, 1.39,3.9) and the consumption of 1,5 aspirins/week (OR, 1.70; 95% CI, 1.01,2.86). Conclusions :,The prevalence of frequent gastro-oesophageal reflux symptoms in Spain is lower than that observed in other Western populations. The psychosomatic symptom score is the factor most strongly associated with gastro-oesophageal reflux symptoms. Long-term gastro-oesophageal reflux symptoms are associated with certain genetic factors (obesity, family history of gastro-oesophageal reflux symptoms), whereas short-term gastro-oesophageal reflux symptoms are associated with factors of probable environmental nature. [source] Effectiveness of early budesonide intervention in Caucasian versus Asian patients with asthma: 3-year results of the START studyRESPIROLOGY, Issue 6 2006Wan C. TAN Objective and background: Few studies have assessed the effectiveness of inhaled corticosteroid therapy exclusively in Asian patients with asthma. The present analysis compared the efficacy of early intervention with inhaled budesonide in Caucasian and Asian patients over the first 3 years of the inhaled Steroid Treatment As Regular Therapy in early asthma study. Methods: Patients aged 5,66 years with mild persistent asthma of ,2 years' duration were randomized to 3 years of double-blind treatment with once-daily budesonide 200 µg (for patients aged <11 years) or 400 µg administered via Turbuhaler or placebo, plus usual asthma therapy. Results: Budesonide significantly improved asthma outcomes in both Caucasian (n = 4661) and Asian (n = 1995) patients compared with reference therapy (placebo plus usual asthma therapy). Budesonide reduced the risk of a first severe asthma-related event by 42% and 49% in Caucasian and Asian patients, respectively, over the 3-year treatment period (P < 0.001 for both). Moreover, budesonide significantly increased symptom-free days, decreased nights with sleeping problems, improved pre- and postbronchodilator FEV1 and reduced the need for additional asthma medications of particular drug classes compared with reference therapy. Except for differences in the patterns of use of additional asthma medications, outcomes with budesonide and overall adverse events were similar in the Caucasian and Asian patient populations. Conclusion: Inhaled budesonide administered once daily in Asian patients with recent-onset, mild persistent asthma significantly improved asthma control and pulmonary function compared with reference therapy. Moreover, this effectiveness paralleled that observed in Caucasian patients. [source] Amoebiasis cutis: Clinical suspicion is the key to early diagnosisAUSTRALASIAN JOURNAL OF DERMATOLOGY, Issue 1 2010Ghanshyam K Verma ABSTRACT Amoebiasis cutis is a rare manifestation of Entamoeba histolytica, primarily an intestinal pathogen, which occurs as a complication of amoebic dysentery. Primary cutaneous amoebiasis occurs from contamination of pre-existing wounds. A high degree of clinical suspicion and demonstration of trophozoites from lesions are important for making an early diagnosis lest these patients should suffer significant morbidity. A HIV-negative and otherwise healthy 40-year-old man presented with a well-defined, indurated, painful, progressively enlarging plaque with overlying ulcers and pus discharging sinuses involving buttocks, perianal/perineal area and part of the left thigh of 3 years' duration. A wide array of investigations was unhelpful but demonstration of Entamoeba histolytica trophozoites in wet-drop preparation from the ulcer margin was diagnostic. The trophozoites were also visualized both in H&E and periodic acid Schiff-stained histological sections. Resolution of lesion was observed 2 weeks after treatment with oral metronidazole 800 mg three times a day and wound care. [source] | ||||||||||||||||||||||||||||