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At least 289 records · Page 16Linked to original sources
PubMed1999

Clinical case definition of malaria at a secondary level hospital in northern India.

Malaria has re-emerged as a major public health problem in India. At present, under the National guidelines; all fevers are presumed to be due to malaria and chloroquine is given as presumptive treatment. This results in overtreatment. We did a pilot study to see whether some clinical predictors of malaria could be identified in the Indian setting. This case control study was done in a secondary level hospital. All those with fever who were smear positive for malaria were enrolled as cases and other patients fever who were smear negative for malaria served as the controls. All the factors under study were ascertained by a history or detailed clinical examination. A total of 41 cases and 95 controls were enrolled. Of the 41 cases, 35 were positive for P. vivax and six were positive for P. falciparum. After multivariate analysis, only splenomegaly (OR = 2.11; 95% CI = 1.27-3.50) and pallor (OR = 2.01; 95% CI = 1.16-3.48) were significantly associated with malaria. It appears that history of fever along with one or both of these two signs can be a useful predictor of malaria in a secondary level hospital in India. The utility and feasibility of a similar approach in a field setting needs to be studied further.

Analysis of Variance↗
PubMed2000

Adverse reactions triggered by dental local anesthetics: a clinical survey.

One hundred and seventy-nine patients completed a questionnaire focusing on adverse reactions to dental local anesthetics as manifested by 16 signs and symptoms. Twenty-six percent of the participants reported having at least 1 adverse reaction. It was found that most of the adverse reactions occurred within the first 2 hours following the injection of local anesthetics. Pallor, palpitations, diaphoresis, and dizziness were the most common adverse reactions reported in the study. The results pointed to a significant relationship between anxiety, gender, injection technique, and procedure with a higher incidence of adverse reactions.

Adolescent↗
PubMed1952

Adenoma of the islets of Langerhans.

An adenoma of the islets of Langerhans may be found anywhere in the pancreas but is more common in the body and tail, and more than one tumor may be present. When such a tumor produces insulin the symptoms observed are those of hyperinsulinism, varying from pallor, sweating, weakness and amnesia in mild cases to coma and convulsions in the more severe. The diagnosis rests largely on Whipple's triad, namely, the onset of symptoms during the fasting period or after exertion, sugar content in the blood of less than 50 mg. per 100 cc. during an attack, and immediate relief of symptoms upon the administration of glucose in one form or another. Surgical removal of an adenoma is the only known cure, and unless it is done the patient will eventually die of the effects of prolonged hyperinsulinism. The procedure entailed may be relatively simple, or fraught with great difficulties and postoperative complications of a major nature. The literature indicates that there has been a mortality rate of 8 or 9 per cent associated with the surgical treatment of this condition.

Adenoma↗
PubMed1985

Preleukemic syndrome in elderly patients--report of 11 cases.

The preleukemic syndrome occurs mainly after middle age. We report 11 patients, aged 62 to 92 years, who presented with weakness, fatigue, malaise and pallor. Eight patients died; survival from the time of diagnosis was between 2 and 21 months. Two of them developed acute myelomonocytic leukemia. A third patient developed Philadelphia chromosome-negative chronic myeloid leukemia within 9 months. Serum unsaturated B12 binding capacity and transcobalamin I were elevated in this patient, preceding the transformation to chronic myeloid leukemia. Five other patients died from sepsis or pneumonia. All patients were anemic, and 10 were leukopenic. Bone marrow was hypocellular in 1 and hypercellular in 10 cases. Chromosomal studies were performed in five patients, with three showing abnormal findings: 47xx, trisomy 8 and a tetraploid karyotype 92xxyy5q-. No cytotoxic treatment should be given during the preleukemic phase until transformation to acute leukemia occurs. Since preleukemic patients are very susceptible to infections, early diagnosis of the condition is important, as is supportive care in the case of surgery.

Aged↗
PubMed1985

Post-vaccination symptoms following DTP and DT vaccination.

Post-vaccination symptoms in 6,004 infants given adsorbed Diphtheria Tetanus and Pertussis (DTP) vaccine and 4,024 infants given adsorbed Diphtheria and Tetanus (DT) vaccine have been compared. Although crying, screaming and fever were slightly more frequent after adsorbed DTP than adsorbed DT, attacks of high-pitched screaming, episodes of pallor and hypotonia, convulsions, other neurological disorders and sudden infant death occurred with similar frequency in the two groups. No specific neurological effect attributable to the pertussis component was found.

Brain Diseases↗
PubMed1995

Using clinical signs to diagnose anaemia in African children.

Anaemia is a serious and common problem among young children in sub-Saharan Africa. As a first step towards developing guidelines for its recognition and treatment, we conducted a study to evaluate the ability of health workers to use clinical findings to identify children with anaemia. Health care workers examined a total of 1104 children under 5 years of age at two hospital-based outpatient clinics in rural Malawi. Blood samples were taken to determine haemoglobin concentrations. Pallor of the conjunctiva, tongue, palm or nail beds was 66% sensitive and 68% specific in distinguishing children with moderate a anaemia (haemoglobin concentration, 5-8 g/dl) and 93% sensitive and 57% specific in distinguishing those with severe anaemia (haemoglobin concentration, < 5 g/dl). Even without laboratory support, which is often unavailable in rural Africa, clinical findings can identify the majority of children with anaemia.

Anemia↗
PubMed1977

Optic disc topography in glaucoma.

An optic disc with glaucomatous cupping is said to be characterized by its extensive excavation, pallor and displacement of disc vessels. All of these features, however, can occur in normal discs. The factors which influence these features in normal eyes are reviewed and an attempt is made to define the differential diagnostic features of the disc in glaucoma.

Adult↗
PubMed2005

Chloroquine resistant malaria in neonates.

OBJECTIVE: To analyze the clinical presentation, treatment given, and outcome of patients suffering from congenital and acquired malaria in neonatal period. DESIGN: Analytical study. PLACE AND DURATION OF STUDY: Paediatrics Ward-2, QAMC/BVH, Bahawalpur for 02 years from October 2001 to October 2003. PATIENTS AND METHODS: The study included 45 cases of neonatal malaria. Thirty cases of malaria, admitted during first ten days of life, diagnosed as congenital malaria, were kept in group A, while 15 cases admitted in the ward from the age of 11 to 28 days, labeled as acquired malaria, were named group B. The clinical features at the time of presentation were noted in each group from the charts having positive malarial parasite (M.P.) on thick and thin slides. The diagnosed cases were treated with the standard dose of chloroquine sulphate. Those patients who improved clinically as well as revealed no parasite on follow-up were labeled as chloroquine sensitive. On the other hand, patients showing poor clinical response with persistence of the parasites in the blood or initially disappearing but later again having a clinical disease with positive M.P. on follow-up, were labeled as chloroquine resistant. They were treated with quinine sulphate. Outcome was compared in both the groups regarding the pattern of chloroquine resistance and death/ survival. Data was collected on which Fischer's exact test of significance was performed to know the level of significance. P-value of < 0.05 was taken as statistically significant. RESULTS: Low birth weight, severe hemolytic anemia with history of fever in the mother were main features in group A while in group B fever, anaemia and history of blood transfusion were marked features. In group A 76.66% were caused by Plasmodium (P.) falciparum. While in group B 60% were caused by Plasmodium vivax. In group A 26.66% were chloroquine resistant while 33.65% were chloroquine resistant in group B. The mortality was 16.66% in group A and 13.33% in group B. CONCLUSION: Intrauterine growth retardation, hemolytic jaundice and history of fever in the mother in the last trimester of pregnancy in the congenital while fever, history of blood transfusion in the neonates in acquired malaria but pallor in both the groups, were important clinical features. Pattern of chloroquine resistance and mortality in both the groups was not statistically different.

Antimalarials↗
PubMed2005

Congenital leukaemia.

This is a case series of three infants who presented with pallor, bruises, and rashes in first month of their life with non specific symptomatology and were diagnosed to have congenital leukaemia. All were of acute myeloblastic leukaemia (AML) M5-FAB type.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1977

Sensorimotor stroke due to thalamocapsular ischemia.

A 61-year-old hypertensive diabetic man awoke with a numb, heavy right arm and leg; symptoms progressed within 30 hours to a dense right hemisensory syndrome involving head, face, trunk, arm, and leg, accompanied by a right hemiparesis, involving tongue, face, arm, and leg with extensor plantar response, leaving him barely able to move the arm and leg against gravity. No impairment in alertness, memory, language, praxic, or visual functions was evident at any time. Improvement in motor function began in 24 hours and progressed to walking status by discharge on day 23. Eight days passed before the sensory deficit showed improvement, and it was still prominent at discharge. Autopsy three months later showed a 4 X 2 X 4-mm lacune in the ventral posterior nucleus of the left thalamus, with a zone of pallor on stained microscopic sections extending into the immediately adjacent posterior limb of the internal capsule. This case appears to be unique in that a sensorimotor stroke has been produced by a confirmed thalamocapsular infarct.

Cerebrovascular Disorders↗
PubMed1993

Pathologic correlates of increased signals of the centrum ovale on magnetic resonance imaging.

The pathologic correlates of increased signal in the white matter of the centrum ovale in postmortem magnetic resonance imaging were investigated in an unselected series of 15 autopsies. Two types of magnetic resonance imaging hyperintensities could be separated on the basis of size (10-mm cutoff): extensive and punctate. The pathologic basis of extensive hyperintensities was large areas of pallor with ill-defined margins, located in the central white matter and sparing the subcortical U fibers on both myelin and axonal stains. Microscopically, these areas showed diffuse vacuolation and significant reduction in the areal densities of glial cells. This change was never seen in areas that did not show extensive white matter hyperdensities on magnetic resonance imaging. The correlates of punctate magnetic resonance imaging hyperintensities were less well defined; dilated Virchow-Robin spaces probably represent a common cause of this phenomenon.

Aged↗
PubMed1996

Motor neuron disease with parkinsonism.

OBJECTIVE: To report clinical characteristics of patients with combined features of parkinsonism and motor neuron disease (MND). DESIGN: Medical chart review. SETTING: University medical center. PATIENTS: Thirteen patients, identified by computer-assisted search, who had diagnoses of both parkinsonism and MND. RESULTS: Median age was 68 years. There were 7 men and 6 women. All had clinical and electrodiagnostic evidence of both upper and lower motor neuron degeneration. One or more clinical manifestations of parkinsonism were observed in all patients either before the diagnosis of MND (n = 2), at the time of initial evaluation (n = 10), or after the diagnosis of MND (n = 1). The median time from symptom onset to presentation was 18 months. Improvement was seen in 5 of the 11 patients treated with levodopa. Dementia and autonomic dysfunction were absent in all patients. Postmortem neuropathological evaluation, available in 1 patient, demonstrated degeneration of the substantia nigra with Lewy bodies, mild pallor of the medullary pyramids, and neurogenic atrophy of the skeletal muscle. CONCLUSION: The onset of MND and parkinsonism within a relatively short period in most of our patients favors a common pathogenic mechanism over coincidental occurrence of 2 unrelated diseases. In patients with MND, it is important to recognize signs of parkinsonism that levodopa might alleviate.

Aged↗
PubMed2004

Severe cerebral white matter involvement in a case of dentatorubropallidoluysian atrophy studied at autopsy.

BACKGROUND: The pathophysiology of white matter involvement in dentatorubropallidoluysian atrophy (DRPLA) is controversial. Moreover, the clinical repercussions and evolution of these lesions have not been well documented. OBJECTIVE: To describe a case of DRPLA with severe cerebellar white matter involvement. DESIGN: Case report. Patient A 62-year-old woman with DRPLA. RESULTS: When the genetic diagnosis was made, the patient manifested severe ataxia, slight dysarthria, and subcortical cognitive impairment. Cranial magnetic resonance imaging showed atrophy of the cerebellum and brainstem and moderate high-intensity signal alterations in the periventricular cerebral white matter in T2-weighted sequences. In the following 5 years, she developed uncontrolled head movements associated with severe bruxism and tetraparesis, and became deeply demented. New magnetic resonance imaging showed severe diffuse cerebral white matter alterations in T2 sequences with only slight progression of brainstem and cerebellar atrophy. After her death at 67 years of age, the autopsy study showed diffuse myelin pallor, axonal preservation, and reactive astrogliosis in the cerebral white matter, with only mild atherosclerotic changes, and moderate neuronal loss in the cerebellum and brainstem. CONCLUSIONS: Leukoencephalopathy could be a prominent finding in some patients with DRPLA, explaining, at least in part, their clinical evolution. In our case, the disproportion between the severity of white matter damage and vascular changes does not support a cardinal role for ischemic mechanisms in leukoencephalopathy.

Female↗
PubMed2006

Essential tremor associated with pathologic changes in the cerebellum.

BACKGROUND: Although essential tremor (ET) is one of the most common neurologic disorders, there have been few postmortem studies. We recently reported postmortem changes (torpedoes and Bergmann gliosis) in the cerebellar cortex in a few ET cases. OBJECTIVE: To describe more extensive postmortem changes in the cerebellum in another ET case. DESIGN: Case report. RESULTS: A 90-year-old woman had a 30-year history of ET. At postmortem examination, there was segmental loss of Purkinje cells, presence of torpedoes, and Bergmann gliosis in the cerebellar cortex. Moreover, there were extensive changes in the dentate nucleus, in the form of neuronal loss, neuronal atrophy, microglial clusters, and reduction in the number of efferent fibers (ie, pallor of the hilum). CONCLUSIONS: The brain in the current case exhibited more marked cerebellar pathologic features than noted in previously reported ET cases and thereby extends the described cerebellar findings in this common, yet pathologically poorly characterized, neurologic disorder.

Aged, 80 and over↗
PubMed1998

Clinical features in affected individuals from 21 pedigrees with dominant optic atrophy.

OBJECTIVE: To assess phenotypic variation of affected individuals from British families with autosomal dominant optic atrophy. DESIGN: Eighty-seven patients from 21 families showing evidence of linkage to chromosome 3q were identified via the Genetic Clinic of Moorfields Eye Hospital, London, England. Genetic linkage analysis was carried out with markers from chromosome 3q28-qter. Patients underwent clinical examination and psychophysical and electrophysiological testing. RESULTS: Best-corrected visual acuity ranged from 20/20 (6/6 m) to light perception. Although visual acuity was not significantly worse in older patients in the group (chi2=3.20, df=4, P>.50), it did deteriorate with age in one third of the families. Subtle or temporal pallor of the optic disc occurred in 96 (55%) of 174 eyes and total atrophy in 76 (44%). Tritanopia was found in 6 (7.5%) of 80 patients; 65 (81.2%) had a mixed color deficit. A cecocentral scotoma was found in the vast majority. Peripheral motion detection threshold was elevated in areas of visual field with raised mean surround sensitivity but not elsewhere. Pattern visual evoked potentials were of reduced amplitude and delayed. Pattern electroretinograms showed a reduced N95 component in keeping with primary ganglion cell dysfunction. CONCLUSIONS: There is wide intrafamilial and interfamilial phenotypic variation in autosomal dominant optic atrophy, with visual function in some, but not all, families deteriorating with age. There is evidence of degeneration of the ganglion cell layer predominantly from central retina, but this is not the exclusive result of either parvocellular or magnocellular cell loss.

Adolescent↗
PubMed2003

Cone dysfunction in patients with late-onset cone dystrophy and age-related macular degeneration.

OBJECTIVES: To determine the clinical and functional findings in patients with late-onset cone dystrophy (LOCD) (after the age of 50 years), which is rare; and to compare them with those of patients with age-related macular degeneration (AMD). METHODS: Eleven LOCD patients underwent ophthalmologic and electroretinographic examinations. Full-field electroretinograms were recorded according to the International Society for Clinical Electrophysiology of Vision standard. The results were compared with those of a group of 20 AMD patients and a group of 23 age-related control subjects. RESULTS: There was no difference between LOCD and AMD patients regarding the severity of visual acuity loss, color vision deficiencies, and central visual field defects. Alterations of the posterior pole were present in all LOCD and AMD patients. In contrast to the AMD group, all LOCD patients did not show drusen and 6 of the 11 LOCD patients displayed temporal optic disc pallor. The electroretinogram revealed the major functional difference, with severe reduction of cone-mediated responses and moderate reduction of rod-mediated responses in LOCD patients. Unexpectedly, the 30-Hz flicker amplitude was reduced in AMD patients compared with healthy controls. CONCLUSIONS: Late-onset cone dystrophy and AMD have several features in common. In elderly patients with progressive visual loss and without drusen, LOCD should be considered. The electroretinographic results in a small group of AMD patients indicate a generalized cone dysfunction.

Aged↗
PubMed2003

Imaging a child's fundus without dilation using a handheld confocal scanning laser ophthalmoscope.

Images of the fundus were acquired in children without pupil dilation using a prototype handheld confocal scanning laser ophthalmoscope (SLO). A 780-nm laser beam imaged a 20 degrees x 20 degrees area of the fundus while a 645-nm beam scanned a fixation target. Scorable images of the optic nerve, macula, and vessels were obtained in 67 (72%) of 93 eyes from pediatric patients with nystagmus, amblyopia, media opacities, or optic nerve or macular abnormalities. Images were obtained in all eyes of pediatric and adult controls. Unsuccessful imaging was associated with media opacities, high refractive error, and poor cooperation. Disadvantages of the SLO were the inability to detect optic nerve pallor or consistently image the periphery. Advantages of the SLO were seen in children with nystagmus, photophobia, eccentric fixation, cone dystrophy, and mild papilledema.

Adolescent↗
PubMed2004

Visual field defects after intravitreous administration of indocyanine green in macular hole surgery.

OBJECTIVES: To report the findings on a patient cohort with visual field defects after macular hole surgery with indocyanine green (ICG)-assisted internal limiting membrane peeling and to investigate the correlation between the defects and the use of ICG. DESIGN: Retrospective, noncomparative interventional case series. PARTICIPANTS: Thirty-nine eyes of 38 patients having the clinical diagnosis of a macular hole who underwent pars plana vitrectomy between January 1, 2001, and December 31, 2002, were enrolled in this study. INTERVENTION: Indocyanine green-assisted internal limiting membrane peeling was performed on a series of 22 eyes: 12 eyes using a 0.5% ICG solution and 3-minute exposure to the retina (group 1), 4 eyes using a 0.5% ICG solution and immediate washout (group 2), and 6 eyes using a 0.25% ICG solution and immediate washout (group 3). The remaining 17 eyes underwent vitrectomy without ICG-assisted internal limiting membrane peeling (group 4). MAIN OUTCOME MEASURES: Visual field, best-corrected visual acuity, and fundus photography were evaluated. RESULTS: Postoperatively, all patients (100%) in group 1 and 1 (25%) of 4 eyes in group 2 had visual field defects. None of the patients in group 3 had a visual field defect. The visual field defects included 10 eyes (84%) with nasal defects, 1 eye (8%) with an inferotemporal defect, and 1 eye (8%) with an extensive visual field defect. Ophthalmoscopy revealed mild to moderate optic disc pallor in 8 (62%) of 13 eyes with postoperative visual field defects. Only 1 patient in group 4 had an inferotemporal defect; none of the other patients in group 4 had visual field defects. There was no statistically significant difference in postoperative visual acuity between patients with and without postoperative visual field defects. CONCLUSIONS: Although this study was limited by the few patients enrolled, our experience indicates that visual field defects, specifically nasal defects, can occur after macular hole surgery with ICG-assisted internal limiting membrane peeling, and that the incidence depends on the concentration of the ICG solution and/or the exposure time to the retina. Further studies are needed to clarify the pathomechanism of visual field defects.

Coloring Agents↗