Showing papers by "British Hospital published in 2015"

Strokes in Sneddon syndrome without antiphospholipid antibodies.

Abstract: Objective Sneddon syndrome (SS) is characterized by the association of a livedo reticularis with stroke. Clinicoradiological features of its neurological manifestations, its prognosis, and the frequency of associated cardiac valvulopathy remain poorly known, particularly in the absence of antiphospholipid antibodies (APL). The objectives were to assess the clinicoradiological pattern of SS without APL (SSAPL−) and its midterm prognosis. Methods Clinical data, transthoracic echocardiograms, and brain imaging of 53 consecutive patients (83% women) with SSAPL−, followed up at our institution between 1991 and 2011, were reviewed. Results Seventy-four strokes were reported; 76% were ischemic strokes (IS), 15% transient ischemic attacks, and 9% hemorrhagic strokes. Heart valve lesions were found in 50% of the cases. Brain imaging showed 177 IS of 3 different types: large territorial (43%), small distal corticosubcortical (14%), and small deep (23%) IS. No significant association was found between the valve involvement and the presence of territorial IS. After a mean follow-up of 7.4 years, 82% of patients had a modified Rankin Scale score ≤ 2. The ischemic event recurrence rate was 20%, with a similar annual rate in the antiplatelet group (3%) compared to the anticoagulation group (2.7%). Interpretation SSAPL− is not only a neurocutaneous disorder, but is frequently associated with heart valve involvement. The latter does not influence the IS type, which suggests that strokes are caused by vasculopathy of the small and medium-size cerebral arteries. Our results show no progression toward a serious disability in the majority of the cases and a moderate recurrence rate under antiplatelet therapy. Ann Neurol 2015;77:817–829

Clinical Characteristics and Prognosis of Incidentally Detected Lung Cancers

Abstract: Objective. To evaluate clinical characteristics and outcomes in incidentally detected lung cancer and in symptomatic lung cancer. Material and Methods. We designed a retrospective study including all patients undergoing pulmonary resection with a curative intention for NSCLC. They were classified into two groups according to the presence or absence of cancer-related symptoms at diagnosis in asymptomatic (ASX)—incidental diagnosis—or symptomatic. Results. Of the 593 patients, 320 (53.9%) were ASX. In 71.8% of these, diagnosis was made by chest X-ray. Patients in the ASX group were older (P = 0.007), had a higher prevalence of previous malignancy (P = 0.002), presented as a solitary nodule more frequently (P < 0.001), and were more likely to have earlier-stage disease and smaller cancers (P = 0.0001). A higher prevalence of incidental detection was observed in the last ten years (P = 0.008). Overall 5-year survival was higher for ASX (P = 0.001). Median survival times in pathological stages IIIB-IV were not significantly different. Conclusion. Incidental finding of NSCLC is not uncommon even among nonsmokers. It occurred frequently in smokers and in those with history of previous malignancy. Mortality of incidental diagnosis group was lower, but the better survival was related to the greater number of patients with earlier-stage disease.

Enteropathogens associated with acute diarrhea in children from households with high socioeconomic level in uruguay

Abstract: Infectious diarrhea, a common disease of children, deserves permanent monitoring in all social groups. To know the etiology and clinical manifestations of acute diarrhea in children up to 5 years of age from high socioeconomic level households, we conducted a descriptive, microbiological, and clinical study. Stools from 59 children with acute community-acquired diarrhea were examined, and their parents were interviewed concerning symptoms and signs. Rotavirus, adenovirus, and norovirus were detected by commercially available qualitative immunochromatographic lateral flow rapid tests. Salmonella, Campylobacter, Yersinia, and Shigella were investigated by standard bacteriological methods and diarrheagenic E. coli by PCR assays. We identified a potential enteric pathogen in 30 children. The most frequent causes of diarrhea were enteropathogenic E. coli (EPEC), viruses, Campylobacter, Salmonella, and Shiga-toxin-producing E. coli (STEC). Only 2 patients showed mixed infections. Our data suggest that children with viral or Campylobacter diarrhea were taken to the hospital earlier than those infected with EPEC. One child infected with STEC O26 developed “complete” HUS. The microbiological results highlight the importance of zoonotic bacteria such as atypical EPEC, Campylobacter, STEC, and Salmonella as pathogens associated with acute diarrhea in these children. The findings also reinforce our previous communications about the regional importance of non-O157 STEC strains in severe infant food-borne diseases.

Induction therapy with cetuximab plus docetaxel, cisplatin, and 5-fluorouracil (ETPF) in patients with resectable nonmetastatic stage III or IV squamous cell carcinoma of the oropharynx. A GERCOR phase II ECHO-07 study.

Abstract: Induction TPF regimen is a standard treatment option for squamous cell carcinoma (SCC) of the oropharynx. The efficacy and safety of adding cetuximab to induction TPF (ETPF) therapy was evaluated. Patients with nonmetastatic resectable stage III/IV SCC of the oropharynx were treated with weekly cetuximab followed the same day by docetaxel and cisplatin and by a continuous infusion of 5-fluorouracil on days 1-5 (every 3 weeks, 3 cycles). The primary endpoint was clinical and radiological complete response (crCR) of primary tumor at 3 onths. Secondary endpoints were crCR rates, overall response, pathological CR, progression-free survival, overall survival, and safety. Forty-two patients were enrolled, and 41 received ETPF. The all nine planned cetuximab doses and the full three doses of planned chemotherapy were completed in 31 (76%) and 36 (88%) patients, respectively. Twelve (29%) patients required dose reduction. The crCR of primary tumor at the completion of therapy was observed in nine (22%) patients. ETPF was associated with a tumor objective response rate (ORR) of 58%. The most frequent grade 3-4 toxicities were as follows: nonfebrile neutropenia (39%), febrile neutropenia (19%), diarrhea (10%), and stomatitis (12%). Eighteen (44%) patients experienced acne-like skin reactions of any grade. One toxic death occurred secondary to chemotherapy-induced colitis with colonic perforation. This phase II study reports an interesting response rate for ETPF in patients with moderately advanced SCC of the oropharynx. The schedule of ETPF evaluated in this study cannot be recommended at this dosage.

Comparative Study between Sequential Automatic and Manual Home Respiratory Polygraphy Scoring Using a Three-Channel Device: Impact of the Manual Editing of Events to Identify Severe Obstructive Sleep Apnea.

Abstract: Objective. According to current guidelines, autoscoring of respiratory events in respiratory polygraphy requires manual scoring. The aim of this study was to evaluate the agreement between automatic analysis and manual scoring to identify patients with suspected OSA. Methods. This retrospective study analyzed 791 records from respiratory polygraphy (RP) performed at home. The association grade between automatic scoring and manual scoring was evaluated using Kappa coefficient and the agreement using Bland and Altman test and intraclass correlation coefficient (CCI). To determine the accuracy in the identification of AHI ≥ 30 eV/h, the ROC curve analysis was used. Results. The population analyzed consisted of 493 male (62.3%) and 298 female patients, with an average age of 54.7 ± 14.20 years and BMI of 32.7 ± 8.21 kg/m(2). There was no significant difference between automatic and manual apnea/hypopnea indexes (aAHI, mAHI): aAHI 17.25 (SD: 17.42) versus mAHI 21.20 ± 7.96 (p; NS). The agreement between mAHI and aAHI to AHI ≥ 30 was 94%, with a Kappa coefficient of 0.83 (p < 0.001) and a CCI of 0.83. The AUC-ROC, sensitivity, and specificity were 0.99 (CI 95%: 0.98-0.99, p < 0.001), 86% (CI 95%: 78.7-91.4), and 97% (CI 95%: 96-98.3), respectively. Conclusions. We observed good agreement between automatic scoring and sequential manual scoring to identify subjects with AHI ≥ 30 eV/h.

Longitudinal Analysis of Female Authorship of Psychiatry Articles in Turkey.

Abstract: Introduction The number of women with careers in medicine and with academic positions at medical schools has increased substantially since the 1980s; however, women remain underrepresented in medical academia, which may be because of the fewer research publications authored by women. This study aimed to determine the gender distribution among Turkish authors of psychiatry articles published in international scientific journals during a 30-year period. Methods The ISI Web of Science database was searched for all psychiatry publications between 1980 and 2009 using the search term Turkey. All articles were classified according to publication period (1980-1989, 1990-1999, 2000-2004, and 2005-2009), gender of the first and last authors, first author title, total number of authors, and type of article. Results In all, 1961 articles meet the study criteria. The first author of 36.5% of the articles and 34.9% of last authors were women. The percentage of female first and last authors did not differ according to publication period (p=0.57). Conclusion To the best of our knowledge this is the first study to examine gender and authorship of psychiatric research in Turkey. In total, 33% of academic positions in Turkish university psychiatry departments were occupied by women, which is comparable to the percentage of female first authors of psychiatric research papers from Turkey. It could be concluded that women academics in psychiatry departments from state universities are as reproductive as their male counterparts, but there is still a "gender gap" in psychiatry field in our country.

Laparoscopic resection of a bulky primary adrenal hydatid cyst

Abstract: A 55-year-old man with no medical history of relevance was referred to our department for chronic back pain. Plain radiographs of the abdomen showed a round calcified image with liquid level inside in the upper-left quadrant. On computed tomography (CT) a bulky solid-cystic mass with calcified wall of 65 × 34 mm was shown in the left adrenal gland with no-contrast enhancement. The patient underwent a laparoscopic approach. Intraoperatively there was a large hard stony mass depending on the left adrenal gland, which was entirely supplanted by the tumor. Complete excision was done. The patient underwent uneventful recovery. Histopathology examination showed a solid-cystic mass with a thick fibrous wall and calcified areas compatible with hydatid cyst. To date there have been published few cases of adrenal hydatid cyst. To our awareness it is the fourth case issued in all literature resected by the laparoscopic approach.

Ligament Reconstruction in Congenital Absence of the Anterior Cruciate Ligament: A Report of Two Cases.

Abstract: Congenital absence of the anterior cruciate ligament (ACL) is an extremely rare condition (0.017 per 1000 live births) [12]. It has been reported as an isolated entity [1, 14] or associated with other abnormalities such as congenital femoral deficiency, fibular hemimelia, scoliosis, hip dysplasia, and dysplasia of the tibial intercondylar eminence [4, 9, 10, 14]. It was first reported by Giorgi [8] in 1956 in a radiographic study, and since then, several case reports have been published [4, 11]. Most reports describe patients with no complaints of instability (despite having positive objective instability tests) but pain due to osteoarthritis of the medial femorotibial joint [12]. Individuals with this condition may not have symptomatic instability if they are able to use muscle forces to provide knee stability. The cases reported with symptomatic instability are likely due to an event that may alter the knee homeostasis making the ACL deficiency manifest [15]. Given the rarity of the condition, there is no consensus regarding the optimal therapeutic approach, although most studies conclude that non-surgical options are the appropriate management despite early degenerative joint disease. Anterior cruciate ligament reconstruction is indicated when symptoms of instability appear [6]. This is a report on two cases of congenital absence of the ACL, one with a femoral length discrepancy and another with a lateral femoral condyle hypoplasia and posterior cruciate ligament (PCL) dysplasia.

Hippocampal Mean Diffusivity is a Biomarker of Neuronal Injury in Patients with Mild Cognitive Impairment and Alzheimer´s Disease Dementia (P6.212)

Abstract: OBJECTIVE: To analyze Mean Diffusivity in Magnetic Resonance Imaging (MD-MRI) at areas of the medial temporal cortex, both in healthy controls and in patients with degenerative amnesic Mild Cognitive Impairment (aMCI) and Alzheimer’s Disease Dementia (ADD). BACKGROUND: Different areas of the medial temporal cortex are usually involved in Alzheimer’s Disease (AD). MD-MRI measurements enable the analysis of water movements at tissue level, and increased diffusivity is associated with the presence of microstructure damages. DESIGN/METHODS: Forty-eight individuals (age 74.71±7.18 years) [16 healthy control individuals, 15 patients with aMCI, and 17 patients with ADD], right-handed, paired by age and education level were included in the study. The findings of MD-MRI among the different groups were analyzed at the level of the hippocampus, the Parahippocampal Gyrus (PG), and the Entorhinal Cortex (EC) with ANOVA (post-hoc Bonferroni test). These findings were correlated with their performance at the California Verbal Learning Test (CVLT), with Pearson test. RESULTS: MD-MRI right hippocampus measurements enabled the identification of 3 groups (ADD-controls: p<0.001, ADD-aMCI: p<0,05, aMCI-controls: p<0.05), with ADD patients presenting with the highest values, and patients with aMCI with intermediate results. Significant differences were noted at the left hippocampus between ADD-aMCI patients (p<0.01) and ADD-controls (p<0.001), without significant differences noted between controls and aMCI patients. Differences were also noted among the groups at the left PG (ADD-controls: p<0.05), left EC (ADD-controls: p<0.05), and right EC (ADD-controls: p<0.01). When analyzing the 3 groups as a whole, the 6 areas assessed showed significant negative correlations between MD-MRI values and patient performance in CVLT coding and delay recall tests. CONCLUSIONS: MD-MRI at these areas revealed differences among the 3 groups, thus reflecting the progressive microstructure damage present throughout the AD spectrum. These findings were also evidenced by patients9 performance at the episodic memory tests based on these structures. Disclosure: Dr. DEMEY has nothing to disclose. Dr. Ventrice has nothing to disclose. Dr. Rojas has nothing to disclose. Dr. Allegri has nothing to disclose. Dr. Zubiri has nothing to disclose. Dr. Somale has nothing to disclose.

The Diagnosis and Treatment of Lower Urinary Tract Symptoms Due to Benign Prostatic Hyperplasia by Primary Care Family Physicians in Portugal

Abstract: Background The shift towards primarily pharmacological management of lower urinary tract symptoms (LUTS) suggestive of benign prostatic hyperplasia (BPH) has led to an increasing proportion of patients being treated in the primary care setting

Donor selection criteria for liver transplantation in Argentina: are current standards too rigorous?

Abstract: Summary Organ shortage is the major limitation for the growth of deceased donor liver transplant worldwide One strategy to ameliorate this problem is to maximize the liver utilization rate To assess predictors of liver utilization in Argentina The national database was used to analyze transplant activity in 2010 Donor, recipient, and transplant variables were evaluated as predictors of graft utilization of number of rejected donor offers before grafting and with the occurrence of primary nonfunction (PNF) or early post-transplant mortality (EM) Of the 582 deceased donors, 293 (503%) were recovered for liver transplant Variables associated with the nonrecovery of the liver were age ≥46 years, umbilical perimeter ≥92 cm, organ procurement outside Gran Buenos Aires, AST ≥42 U/l and ALT ≥29 U/l The median number of rejected offers before grafting was 4, and in 71 patients (25%), there were ≥13 The only independent predictor for the occurrence of PNF (34%) or EM (52%) was the recipient’s emergency status During 2010 in Argentina, the liver was recovered in only half of donors The low incidence of PNF and EM and the characteristics of the nonrecovered liver donors suggest that organ acceptance criteria should be less rigorous

Tracheobronchial Tuberculosis Without Lung Involvement.

Abstract: Endotracheal tuberculosis (ETTB) is an infrequent form of tuberculosis whose major feature is the infection of the tracheobronchial tree by Mycobacterium tuberculosis. This case presents a 73-year-old man admitted to our hospital with fatigue, weakness, dry cough and weight loss. His chest X-ray was normal but the high resolution computed tomography (HRCT) showed normal parenchyma images with mediastinal and hilar lymphadenopathy. There was inflammation of the tracheal wall and infiltrates in pavement epithelium; however, the tracheal biopsy for acid-fast bacilli was negative. He was finally diagnosed by endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) of the lymph nodes. Four drugs were prescribed and symptoms improved. EBUS-TBNA contributed to prompt diagnosis. The patient was treated and evolved without complications, such as tracheal stenosis.

Laparoscopy After Liver Transplant: Result of an Initial Series.

Abstract: There are few reports about laparoscopic approach after liver transplantation (LT). The aim of this paper is to analyze in terms of feasibility and therapeutic effectiveness an initial experience with laparoscopy in patients who have had a liver transplantation. Methods Laparoscopic procedures were divided into “early” and “late” laparoscopy. Results A total of 10 laparoscopic procedures after LT were performed in 9 patients: 3 early and 7 late. The early laparoscopic procedures were performed in 3 patients who had a torpid evolution in their liver transplant: 2 were diagnostic only and 1 was also therapeutic. There were no intraoperative events or conversions. We recorded 2 complications. In 7 patients a late laparoscopy was performed: 4 in the upper abdomen and 3 in the lower abdomen. Of the 4 in the upper abdomen, 3 were liver procedures and 1 was in the transverse colon, on the other side; in addition, 2 laparoscopic inguinal hernia repairs and 1 laparoscopic appendectomy also were performed. None of these 7 cases was converted, and there were no intraoperative events. Conclusions The early postoperative period, in critically ill patients diagnostic and eventually therapeutic laparoscopy was feasible and effective in our cases. Late laparoscopy in the upper abdomen is difficult due to adhesions and adds to the risk of poor graft function, but was feasible for both diagnostic and therapeutic purposes. Late laparoscopy in the lower abdomen with good graft function has the same safety and efficacy as those performed on nontransplanted patients.

Alzheimer’s Disease Dementia involves the Corpus Callosum and the Cingulum: A Diffusion Tensor Imaging Study (P6.210)

Abstract: OBJECTIVE: Using Diffusion-Tensor Imaging by Magnetic Resonance Imaging (DTI-MRI), to assess the involvement of the Corpus Callosum (CC), the cingulum, and other nerve pathways, both in healthy individuals and in patients with Alzheimer’s Disease Dementia (ADD). BACKGROUND: In its natural course, Alzheimer’s disease involves the brain’s White Matter (WM) microstructure, and the WM of pathways carrying highly relevant information for cognitive performance. DTI-MRI enables the measurement of the WM microstructure through Fractional Anisotropy (FA), and Mean Diffusivity (MD). DESIGN/METHODS: Thirty-three patients were included in the study: 16 healthy controls [age: (mean±Standard Deviation) 73.31±6.48 years; education: 12.06±4.15 years, MMSE: 29.56±0.62], and 17 patients with probable ADD (NINCDS-ADRDA) [age: 75.06±8.84 years; education: 11.65±4.47 years, MMSE: 20.65±6.42], right-handed, paired by age, education, and Beck’s inventory. A full neuropsychological test battery was administered, and DTI-MRI was taken (21 directions, 3-mm slice thickness). FA and MD findings were analyzed at the level of the CC, the cingulum, and of other selected pathways. Demographic data and findings of DTI-MRI were analyzed by ANOVA among the groups. RESULTS: Regarding FA, patients with ADD presented with lower values than healthy controls at the left cingulum (cingulate-gyrus area=p:0.001; hippocampus area=p:0.001), and the right cingulum (cingulate-gyrus area=p:0.023), and at the left CC (genu=p:0.003; corpus=p:0.022; splenium=p:0.005), and the right CC (genu=p:0.005; corpus=p:0.011; splenium=p:0.002). In terms of MD, patients with ADD presented with the highest values at the left cingulum (cingulate-gyrus area=p:0.001; hippocampus area=p<0.001), and the right cingulum (cingulate-gyrus area=p<0.001; hippocampus area=p:0.004), and at the left CC (genu=p:0.006; corpus=p:0.016; splenium=p:0.006), and the right CC (genu=p:0.019; corpus=p:0.018; splenium=p:0.001). CONCLUSIONS: The involvement of the WM microstructure in patients with ADD was evidenced through FA and MD measurements, at highly relevant pathways for cognitive performance. Disclosure: Dr. DEMEY has nothing to disclose. Dr. Ventrice has nothing to disclose. Dr. Rojas has nothing to disclose. Dr. Zubiri has nothing to disclose. Dr. Somale has nothing to disclose.

Severe Spinal Injury in Hirayama Disease

Abstract: Hirayama disease is a rare neurological disorder characterized by an insidious progressive subacute unilateral or bilateral weakness of the hands and forearm muscles leading to a painless amyotrophy. The disease primarily affects young men in the second to third decades of life. It has always been described as a second motor neuron disease, thus sparing the pyramidal and sensitive pathways. It usually has a slow progression course of 3 to 5 years followed by stabilization. Since its initial description by Keyzo Hirayama in 1959, most cases have been reported in Asia, particularly Japan and India, although the disease reportedly has worldwide distribution.

Chronic balance disorders after acoustic neuroma surgery: assessment of gravitational vertical perception.

Abstract: Conclusion: The head tilt response (HTR) test performed in a group of patients with chronic dizziness after acoustic neuroma surgery showed alterations in the gravitational vertical perception (GV). Objective: The assessment of the accuracy in the GV through the HTR test in patients with long-term balance disorders after acoustic neuroma surgery. Methods: The HTR was performed in two groups of patients that had undergone acoustic neuroma surgery: six uncompensated patients (UPs) who maintained vestibular symptoms 1 year after surgery and two compensated patients (CPs) without vestibular symptoms. Twelve healthy control adults were also tested (control group, CG). Three parameters were measured in the HTR test: steady-state error (SSE), rise time (TRS), and mean energy of the error signal per step (MEE). Results: The UP group showed higher values for the TRS and MEE parameters compared with the CG (p < 0.05) when performing the HTR test to the side of the lesion and to the contralateral side, while...

Effect of levetiracetam on hepatic fibrosis in diabetic rats

Abstract: Objectives: In our study we investigated the possible effects of levetiracetam (LEV) on hepatic fibrosis in streptozotocin (STZ) induced diabetic rats with histopathology, real-time elastography imaging technique. We also aimed to investigate the effects of LEV on oxidative stress markers. Materials and methods: Diabetes was induced by intraperitoneal (i.p.) single dose injection of STZ (60 mg/kg). Twenty-one rats were randomly divided into three groups; control group, STZ group treated with 1 mL/kg/day saline (STZ+SP), and STZ group treated with 600 mg/kg/day LEV was administrated by i.p. for four weeks. All rats underwent a real-time elastography (strain-elasticity %). The liver sections are examined by histopathologically (liver fibrosis score). In addition, malondialdehyde, total antioxidant capacity, and glutathione levels were measured in plasma. Results: Treatment with LEV significantly decreased liver fibrosis score and increased strain measurement % on the real-time elastography in diabetic rats. In addition, treatment with LEV significantly increased total antioxidant capacity, glutathione and malondialdehyde levels decreased in plasma of diabetic rats. Conclusion: Levetiracetam has potential as a treatment for diabetic liver injury and hepatic fibrosis and can be a good candidate among new treatment options. In addition, real-time elastography is reliable imaging non-invasive technique for detecting hepatic fibrosis. Keywords: Diabetes mellitus; levetiracetam; oxidative stress; real-time elastography.