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Showing papers by "Lincoln Hospital published in 2008"


Journal ArticleDOI
TL;DR: Hydroxyurea has benefited some patients with sickle cell disease, but several issues about its use are unresolvable.
Abstract: Hydroxyurea has benefited some patients with sickle cell disease—an inherited blood disorder that affects 50 000 to 100 000 people in the United States—but several issues about its use are unresolv...

258 citations


Journal ArticleDOI
01 Jan 2008-Drugs
TL;DR: There is no single diagnostic test for AOSD, and diagnosis is based on clinical criteria and usually necessitates the exclusion of infectious, neoplastic and autoimmune diseases.
Abstract: Adult-onset Still's disease (AOSD) is a rare, systemic inflammatory disease of unknown aetiology, characterized by daily high spiking fevers, evanescent rash and arthritis. Our objective was to review the most recent medical literature regarding advances in the understanding of disease pathogenesis, diagnosis and treatment. There is no single diagnostic test for AOSD, and diagnosis is based on clinical criteria and usually necessitates the exclusion of infectious, neoplastic and autoimmune diseases. Laboratory tests are nonspecific and reflect heightened immunological activity with leukocytosis, elevated acute phase reactants and, in particular, extremely elevated serum ferritin levels. Abnormal serum liver function tests are common, while rheumatoid factor and antinuclear antibodies are usually absent. Recent studies of the pathogenesis of the disease have suggested an important role for cytokines. Interleukin (IL)-1, IL-6 and IL-18, macrophage colony-stimulating factor, interferon-gamma and tumour necrosis factor (TNF)-alpha are all elevated in patients with AOSD. Prognosis depends on the course of the disease and tends to be more favourable when systemic symptoms predominate. Treatment includes the use of corticosteroids, often in combination with immunosuppressants (e.g. methotrexate, gold, azathioprine, leflunomide, tacrolimus, ciclosporin and cyclophosphamide) and intravenous immunoglobulin. Biological agents (e.g. anti-TNFalpha, anti-IL-1 and anti-IL-6) have been successfully used in refractory cases. Further progress has been hampered by the rarity and heterogeneity of the disease, which has not permitted the execution of randomized controlled studies.

97 citations


Journal ArticleDOI
TL;DR: MetSynd is more prevalent in HIV-seropositive than HIV-Seronegative women, and this increased prevalence was due to dyslipidemias rather than higher blood pressure, glucose, or waist circumference.
Abstract: Objectives: To assess the prevalence of metabolic syndrome (MetSynd) among participants of the Women's Interagency HIV Study and to describe the association of MetSynd with HIV infection, antiretroviral therapies, and sociodemographic factors Methods: Prevalence of MetSynd, defined by updated Adult Treatment Panel III guidelines, was assessed among 2393 (1725 sero-positive and 668 seronegative) participants from the Women's Interagency HIV Study seen between October 2000 and October 2004 Results: HIV-1 infection was independently associated with MetSynd [33% vs 22%, P 50,000 vs <80 copies/mL); and use of stavudine (OR= 128, P= 0009) Nevirapine use was protective (OR = 075, P = 0016) There was no significant association of MetSynd with ritonavir-boosted protease inhibitors (OR = 115, P = 0134) Conclusions: MetSynd is more prevalent in HIV-seropositive than HIV-seronegative women This increased prevalence was due to dyslipidemias rather than higher blood pressure, glucose, or waist circumference

78 citations


Journal ArticleDOI
TL;DR: Measurement of plasma AdoMet levels in patients with HIV infection who have pulmonary infections can identify those with PCP.
Abstract: BACKGROUND: S-adenosylmethionine (AdoMet) is a key molecule involved in methylation reactions and polyamine synthesis. Pneumocystis carinii are unable to synthesize this molecule and have been shown to scavenge this metabolic intermediate from the plasma of rats during active infection. A prior study involving humans strongly suggested that low levels of plasma AdoMet are sensitive and specific indicators of acute infection. METHODS: From March 2004 through January 2006 we collected plasma AdoMet levels from patients with human immunodeficiency virus (HIV) infection and either confirmed Pneumocystis carinii pneumonia (PCP) confirmed pulmonary tuberculosis or confirmed bacterial pneumonia. We compared levels in patients with PCP with those in patients with other diseases and also monitored changes in levels during treatment of PCP. RESULTS: Initial AdoMet levels were significantly lower in patients with PCP and there was no overlap between the groups. Among patients with PCP levels of AdoMetincreased with successful treatment. CONCLUSIONS: Measurement of plasma AdoMet levels in patients with HIV infection who have pulmonary infections can identify those with PCP.

50 citations


Journal ArticleDOI
TL;DR: A case of sinusitis causing a subdural empyema in an otherwise healthy immunocompetent adolescent boy is reported and may lead to irreparable brain damage or death.
Abstract: Acute sinusitis is a common childhood illness most often involving the ethmoid and maxillary sinuses. Diagnosis is usually based on a history of an upper respiratory tract infection lasting longer than 7 days with a prominent nasal component. Treatment involves 10–14 days of antibiotics. Intracranial complications of pediatric sinusitis are rare, but potentially life-threatening. These include cavernous sinus thrombosis, orbital and intracranial extension, and meningitis. Children with these complications may experience significant morbidity from their infection. In such cases, delay in diagnosis and treatment may lead to irreparable brain damage or death. We report a case of sinusitis causing a subdural empyema in an otherwise healthy immunocompetent adolescent boy.

30 citations


Journal ArticleDOI
TL;DR: The interstitial deletion of bands q33–35 of long arm of chromosome 7: a review with a new case report shows clear trends in progenitor cell reprograming and appears to be a “window of opportunity” for use in further studies.
Abstract: Verma RS, Conte RA, Sayegh SE, Kanjilal D. The interstitial deletion of bands q33–35 of long arm of chromosome 7: a review with a new case report. Clin Genet 1992:41: 82–86. Interstitial or terminal deletion resulting in partial monosomy of various segments of the long arm of chromosome 7 was first recorded over two decades ago. Since then, a number of reports have correlated the severity of clinical manifestations with the length of the deletion involved. However, difficulty remains in defining a so-called “distinct syndrome”. We present a new case with the shortest interstitial deletion of the long arm of chromosome 7 bands q33–35, i.e. 46,XX,del(7)(pter q33::q35 qter). A 4-year-old black female was referred for cytogenetic evaluation due to neurodevelopmental delay. Pertinent physical examination at birth was cleft lip and cleft palate which required corrective surgery. At 2 years of age, a myringotomy tube was inserted for repeated ear infection and a hearing aid was required for conductive deafness. Neurological examination revealed poor eye contact, and severe mental and motor retardation. We reviewed 21 cases of a partial interstitial deletion of varied segments of the long arm of chromosome 7, but we were unable to establish a definite relationship with the deletion of various 7q segments with any specific clinical manifestations.

22 citations


Journal ArticleDOI
TL;DR: A case of stump appendicitis is reported 2 years after laparoscopic appendectomy in a child with right lower quadrant pain and a surgical history of appendectomy.
Abstract: Stump appendicitis, although rare, is a real entity that is often not considered during the evaluation of children with right lower quadrant pain and a surgical history of appendectomy. The history of appendectomy in a child may delay the diagnosis and management of this entity by misleading the physician into thinking that this patient could never have appendicitis again. However, the diagnosis of appendicitis should be considered in any patient with right lower quadrant pain, even if there is a history of appendectomy. We report a case of stump appendicitis 2 years after laparoscopic appendectomy. A review of the pertinent literature is included.

19 citations


Journal Article
TL;DR: Recent advances in the study of a subset of NOD-like receptors, which control the activation of caspase-1 through the assembly of a large protein complex called inflammasome, are reviewed.
Abstract: The autoinflammatory syndromes are a group of disorders characterized by recurrent episodes of seemingly unprovoked inflammation without significant levels of autoantobodies and antigen specific T cells. Although a direct association between defective innate immune responses to bacterial components and these diseases has not been formally established, much ongoing research is aimed towards confirmation of that hypothesis. This article will review recent advances in the study of a subset of NOD-like receptors (NLRs), which control the activation of caspase-1 through the assembly of a large protein complex called inflammasome. Moreover, we will review recent progresses in understanding of a range of autoinflammatory conditions in humans.

15 citations


Journal ArticleDOI
TL;DR: The authors thank the MD-AL study team for their fieldwork in evaluating participants and the management and staff of participating AL facilities, and the staff at Copper Ridge for their dedication and assistance in the development and implementation of the study.
Abstract: ACKNOWLEDGMENTS We are grateful to the MD-AL study team for their fieldwork in evaluating participants. We wish to thank study participants, their families, the management and staff of participating AL facilities, and the staff at Copper Ridge for their dedication and assistance in the development and implementation of the study. Conflict of Interest Dr. Rabins has an ownership interest in DEMeasure. DEMeasure holds the copyright for the Alzheimer’s disease–related QOL (ADRQL) measure used in this study. Under an agreement between DEMeasure and Dr. Peter V. Rabins, Dr. Rabins is entitled to a share of fees received from sales of the questionnaire and scale. Neither the company nor Dr. Rabins received a share of fees received from questionnaires used in this study. Dr. Lyketsos has received grant support (research or continuing medical education) from Forest, Glaxo-Smith Kline, Eisai, Pfizer, Astra-Zeneca, Lilly, Ortho-McNeil, Bristol-Myers, and Novartis and is an adviser for Astra-Zeneca, Glaxo-Smith Kline, and Supernus. Dr. Rosenblatt serves on the speaker’s bureau for Pfizer. Supported by Grant R01MH60626 from the National Institute of Mental Health and the National Institute on Aging. Author Contributions: Drs. Rosenblatt, Lyketsos, Brandt, and Rabins played a role in study concept, acquisition of subjects and data, analysis and interpretation of data, and preparation of the manuscript. Drs. Samus, Onyike, Baker, and McNabney played a role in acquisition of subjects and data, analysis and interpretation of data, and preparation of the manuscript. Dr. Mayer played a role in analysis and interpretation of data and preparation of the manuscript. Sponsor’s Role: The sponsor (NIMH and NIA) played no role in the design, methods, subject recruitment, data collection, analysis, or preparation of the manuscript.

11 citations


Journal ArticleDOI
TL;DR: The need to consider alternative diagnoses including congenital diaphragmatic hernia in the evaluation of recurrent respiratory symptoms if the presentation is not consistent with asthma or there are asymmetric findings on auscultation is considered.
Abstract: Many children are brought to the emergency department because of respiratory symptoms including wheezing. Asthma is the most common but not the only cause of wheezing in children. There are many conditions, both pulmonary and extrapulmonary, which may cause recurrent wheezing. The diagnosis in children with congenital diaphragmatic hernia may be delayed. The late presentation of congenital diaphragmatic hernia poses a considerable diagnostic challenge. We report an 18-month-old child with congenital diaphragmatic hernia who presented with recurrent respiratory symptoms and localized physical findings. This case underscores the need to consider alternative diagnoses including congenital diaphragmatic hernia in the evaluation of recurrent respiratory symptoms; this is especially true if the presentation is not consistent with asthma or there are asymmetric findings on auscultation.

7 citations


Journal ArticleDOI
TL;DR: Most OMFS residents perceive that the Bell Commission guidelines have a positive impact on their residency training and on patient care, and recommend further studies to evaluate the effects of this study on OMFS training.

Journal ArticleDOI
TL;DR: A child with pancreatic injury without an appropriate history of trauma, determined to be caused by nonaccidental trauma is reported.
Abstract: The diagnosis of abuse in a child with occult abdominal injuries is difficult. Not many patients with nonaccidental trauma present with a clear history of the injury. The absence of a reliable history in patients with nonaccidental trauma makes determination of an exact mechanism difficult. In most cases, patients present to the emergency department with inaccurate or misleading histories; some give no history of trauma, which may delay recognition of serious abdominal injuries. In addition, the child may have other injuries, such as neurologic or musculoskeletal, which divert attention from occult abdominal injuries. Pancreatic and duodenal injuries are considered specific for abuse. We report a child with pancreatic injury without an appropriate history of trauma, determined to be caused by nonaccidental trauma.

Journal ArticleDOI
TL;DR: A case of severe failure to thrive in an infant due to neonatal form of Bartter syndrome, its manifestations, management, and outcome is presented.
Abstract: Failure to thrive in an infant has multiple etiologies and at times, is only manifestation of underlying serious disease. Bartter syndrome is a rare disease that manifests as failure to thrive. It can be diagnosed by a careful history, physical examination, and abnormal electrolyte pattern. It can be alleviated by appropriate management, whereas failure to recognize early can be life threatening. A case of severe failure to thrive in an infant due to neonatal form of Bartter syndrome, its manifestations, management, and outcome is presented in this article.

Journal ArticleDOI
TL;DR: Strategies for responding to patients and their family members who request a physician on the basis of sex and how to respond should be considered.
Abstract: Strategies for responding to patients and their family members who request a physician on the basis of sex. Virtual Mentor is a monthly bioethics journal published by the American Medical Association.

Journal ArticleDOI
TL;DR: An adolescent who presented with lower extremity pain and a careful evaluation revealed an abdominal mass was reported, and further investigation determined the presence of iliofemoral deep venous thrombosis and absence of the inferior vena cava.
Abstract: Musculoskeletal pain is a common symptom among active adolescent in the emergency department. The etiologic list is broad and range from benign to potential life-threatening conditions. Deep vein thrombosis is a rare cause of lower extremity pain in children. We report an adolescent who presented with lower extremity pain and a careful evaluation revealed an abdominal mass. Further investigation determined the presence of iliofemoral deep venous thrombosis and absence of the inferior vena cava. Absence of inferior vena cava is an uncommon congenital malformation in children and is a possible risk factor for the development of venous thrombosis. This case emphasizes the importance of thorough physical examination in children with nonspecific symptoms. If venous thrombosis is identified, especially in patients without any apparent risk factors, congenital anomalies of inferior vena cava should be considered. The pertinent literature is reviewed.

Journal ArticleDOI
Neal Spivack1
TL;DR: A model of inpatient group psychotherapy that focuses on two frequently observed patient subgroups reflecting contrasting attitudes toward authority is presented, and a three–stage group designed to help patients achieve these goals is described.
Abstract: A model of inpatient group psychotherapy that focuses on two frequently observed patient subgroups reflecting contrasting attitudes toward authority is presented. The counterdependent subgroup overly values autonomy, opposes unit restrictions, and rejects treatment. The dependent subgroup tends to accept the unit's treatment and structure but is overly passive. In this model these attitudes are addressed in order to help patients adapt to the unit and to facilitate discharge. The author describes a three-stage group designed to help patients achieve these goals.



Journal ArticleDOI
TL;DR: A case of an 11-year-old girl with acute necrotizing pancreatitis, who was initially diagnosed as having new onset diabetes with nonketotic hyperglycemia, is reported.
Abstract: Hyperglycemia, abdominal pain, and vomiting are the most common manifestations of diabetic ketoacidosis in pediatric patients. The absence of ketonemia in these patients should prompt a consideration of acute pancreatitis. We report a case of an 11-year-old girl with acute necrotizing pancreatitis, who was initially diagnosed as having new onset diabetes with nonketotic hyperglycemia.

Journal Article
TL;DR: A case of acute profound weight loss due to herniation of the stomach through the foramen of Morgagni is described and a review of the literature is reviewed.

Journal ArticleDOI
01 Oct 2008-Europace
TL;DR: The investigators have created clinically significant adverse events scoring system based on assigning arbitrary weights to actual events that may artificially change the value of the analysed events.
Abstract: Regarding the DATAS randomized study by Almendral et al. , 1 we would like to comment on methodological issues that may limit the validity of the results of this trial. The investigators have created clinically significant adverse events (CSAEs) scoring system2 based on assigning arbitrary weights to actual events that may artificially change the value of the analysed events, …