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PubMed1979

IgA and IgG antibody activities of serum and bronchoalveolar fluid from symptomatic and asymptomatic pigeon breeders.

Serum IgA and IgG antibody activities against pigeon serum were measured in 16 symptomatic pigeon breeders, 20 asymptomatic pigeon breeders, and 3 normal subjects by radioimmunoassay. The IgA and IgG antibody activities against pigeon antigen of the group of patients with disease was significantly greater than those of patients in the asymptomatic and the control group. The overlap of results for the symptomatic and asymptomatic breeders limits the diagnostic value of these individual IgA or IgG antibody determinations. Bronchoalveolar fluid and serum samples from a smaller group of pigeon breeders who underwent lung lavage were available for studies of antibody activity against pigeon serum. Ten asymptomatic and 6 symptomatic breeders were available for study. Both IgG and IgA antibody activities were detected by radioimmunoassay in serum samples and bronchoalveolar fluid. The IgA antibody activity determined by the radioimmunoassay was higher in the respiratory secretions.

Alveolitis, Extrinsic Allergic↗

PubMed1978

Asymptomatic hyperuricemia: the case for conservative management.

The management of asymptomatic hyperuricemia is controversial. Reported benefits from treatment prevention of acute gouty arthritis, chronic tophaceous gout, urolithiasis, or gouty nephropathy. A review of experimental and clinical data suggests that the risks of asymptomatic hyperuricemia are small or unknown and the efficacy of long-term treatment in preventing gout or renal disease is unproved. The costs and risks of prolonged drug administration and practical considerations such as patient compliance mitigate against long-term therapy in asymptomatic persons. We offer some recommendations for an expectant approach to the management of asymptomatic hyperuricemia.

Gout↗

PubMed1976

Lung function studies in asymptomatic individuals with moderately (Pi SZ) and severely (Pi Z) reduced levels of alpha1-antitrypsin.

Extensive physiological evaluation of lung function were conducted in two groups of asymptomatic individuals with deficiencies of alpha1-antitrypsin: seven subjects with phenotype Pi SZ and six subjects with phenotype Pi Z. Four symptomatic individuals of Pi Z type were also investigated. The asymptomatic individuals of both SZ and Z phenotypes revealed reduction of elastic recoil, hypoventilation and hypoperfusion of the lung bases with increased closing and nitogen wash-out volumes. No signs of bronchial obstruction were observed. The asymptomatic Pi SZ subjects revealed as many signs of subclinical disease as did the asymptomatic Pi Z subjects. These data suggest that Pi SZ subjects are at increased risk of emphysema similar to Pi Z subjects.

Adult↗

PubMed1975

Asymptomatic male and female gonorrhoea.

Three hundred and ninety-nine patients attending the out-patient clinic of the Department of Dermatology and Venereology, Rigshospital, Copenhagen, for various venereal complaints were examined during a three-month trial. Neisseria gonorrhoeae was found in 75 female and 89 male patients. 43 women (57%) and 13 men (15%) were asymptomatic at the first visit. The duration of the asymptomatic period exceeded 3 weeks in 25 female (33%) and 7 male (8%) patients. The asymptomatic period in the male group varied from 15 to 90 days and from 4 to 180 days in the females. The majority of the patients with asymptomatic gonorrhoea had been exposed to a sexual contact with proven gonococcal infection, thus emphasizing the importance of contact investigation.

Adolescent↗

PubMed1977

[Clinical, biochemical and morphological characteristics of asymptomatic and oligosymptomatic types of chronic glomerulonephritis].

The results of our study confirm that an early and certain diagnosis of the asymptomatic and oligosymptomatic forms of the chronic glomerulonephritis is possible only using comprehensive clinical and biochemical investigation methods and partly the renal biopsy. Only with regard to the clinical manifestation the disease has an asymptomatic or oligosymptomatic course. Some laboratory findings have been changed from the beginning of the disease. The degree of these changes as well as the further existence of the asymptomatic or oligosymptomatic form depend on the pathomorphological type of the disease. But even in the cases with a favourable development a gradual reduction of the renal function was observed. The pathologically decreased values of haploglobin and sialic acid reveal the clear activity of the pathological process. These facts emphasize the necessity to perform systematically prophylactic and therapeutic measures in all cases with asymptomatic or oligosymptomatic chronic glomerulonephritis.

Adult↗

PubMed1977

Noninvasive evaluation and management of the "asymptomatic" carotid bruit.

Cervical bruits in patients who are asymptomatic or who have nonhemispheric neurological symptoms present a universal challenge. Of 4,000 patients evaluated noninvasively for carotid occlusive disease, 1,287 presented with "asymptomatic" bruits (697 had nonhemispheric neurological symptoms and 590 were clinically asymptomatic). Carotid phonoangiography (CPA), the visual analysis of carotid bruits, identifies bruits indicative of significant stenosis, documents progression, and differentiates bruits of carotid bifurcation and sub-bifurcation origin. Sub-bifurication bruits were diagnosed in 619, insignificant bifurcation bruits in 426, and significant carotid bruits in 242 patients by CPA. Oculoplethysmography (OPG) evaluates the hemodynamic significance of carotid bruits by comparative timing of simultaneously recorded ocular and ear lobe pulses. OPG detected 273 asymptomatic bruit patients with significant internal carotid flow reduction and indicated 5% of the bifurcation bruits were of external carotid origin. An accuracy of 89% in determining greater than 40% stenosis by OPG/CPA in 295 patients having arteriography increases to 97% when both OPG and CPA are positive. Six-month to 70-month clinical follow-up of the 1,287 patients documented 154 carotid endarterectomies and 38 strokes. Analysis of the strokes favors arteriography and operation only for those patients with appropriately positive or progressive OPG/CPA or with focal transient ischemic attacks (TIAs).

Auscultation↗

PubMed1976

Treatment of asymptomatic diabetes mellitus.

A large number of individuals currently diagnosed as having diabetes mellitus are asymptomatic. In order to provide rational therapy for this patient population, it is necessary to focus upon the differences between these patients and the classic prototypes with polyuria and weight loss, who require insulin for survival. Patients with asymptomatic diabetes do not need insulin for survival, and, by definition, they do not need it to alleviate symptoms. They tend to be middle-aged and overweight, but they can be young and thin. Their degree of hyperglycemia is moderate, often indistinguishable from that of normal individuals in their day-to-day existence. Indeed, they can often be differentiated from normal persons only on the basis of their blood glucose response to the stress of a large dextrose challenge; in this regard, the potential problem of over-diagnosing diabetes has been discussed. Since the major problem facing patients with asymptomatic diabetes is accelerated atherogenesis, the therapeutic approach must be based upon efforts to delay or prevent the onset of vascular disease. It has yet to be shown that any therapeutic intervention helps such patients, but an argument has been made in support of the following goals in subjects with asymptomatic diabetes whose fasting blood glucose level is less than 170 mg/100 ml: (1) stop smoking, (2) control hypertension, (3) attain ideal body weight, and (4) maintain blood triglyceride and cholesterol levels well within normal limits. Attempts to lower blood glucose with either insulin or oral agents do not seem indicated in the majority of patients within this defined diabetic population.

Diabetes Mellitus↗

PubMed1979

Asymptomatic transient uveitis in children with inflammatory bowel disease.

Although acute anterior uveitis has been noted in children with inflammatory bowel disease, it has not been appreciated in the absence of ocular symptoms. To determine the presence of asymptomatic uveitis, slit-lamp examinations were performed in 19 children with granulomatous bowel disease and seven with ulcerative colitis. In the former group, six had uveitis, while no abnormalities were noted in those with ulcerative colitis. Abnormalities consisted of cells and flare in the anterior chamber. In the group with asymptomatic uveitis, all were male, three were black, and all had colonic involvement. No positive correlations were noted between the presence of uveitis and bowel symptoms, duration of illness, extraintestinal manifestations, or specific treatment regimens. None of the six children with uveitis had evidence of spondylitis, and five were HLA-B27-negative. Repeated eye examinations six to 12 months later disclosed no evidence of uveitis in four of five children and improvement in the remaining child. These data suggest that asymptomatic transient uveitis is common in children with granulomatous bowel disease, but progression to severe adult uveal disease remains unclear.

Adolescent↗

PubMed1976

Asymptomatic bacteriuria in pregnancy: antibody-coated bacteria, renal function, and intrauterine growth retardation.

Asymptomatic bacteriuria (greater than 100,000 microorganisms per milliliter) was found in 70 of 1,400 pregnant women without symptoms referable to the urinary tract (five per cent). With the fluorescent antibody (FA) tests, antibody-coated bacteria were demonstrated in specimens from 35 patients (50 per cent), indicating silent renal bacteriuria. Although confirmation by direct localization methods was not feasible in this group of patients, indirect evidence of renal function impairment associated with the presence of antibody-coated bacteria was suggested by results of the serum creatinine and creatinine clearance tests. The outcome of the pregnancy was compared for patients with bacteriuria (FA-negative or FA-positive tests). An association between the presence of asymptomatic renal bacteriuria and intrauterine growth retardation was noted. Thus, the patient with asymptomatic bacteriuria and a positive FA test is at greater risk of delivering an intrauterine growth-retarded infant.

Bacteriuria↗

PubMed1978

Conjunctiva in asymptomatic contact lens wearers.

Biopsy specimens of the upper tarsal conjunctiva from 11 asymptomatic, biomicroscopically normal contact lens wearers (five hard and six soft) were studied by scanning electron microscopy. The conjunctiva in lens wearers showed areas of normal epithelial cell surfaces interspersed among areas of altered cells. The altered cell surfaces were characterized by centralized clumped microvilli and baring of that portion of plasma membrane around the cell periphery. The degree of centralization of microvilli varied widely, from a mild tendency to centralize accompanied by slight reduction in cell diameter, to an exteme centralization and dramatic diameter reduction. In some cells, the centralized microvillar structure had a unique mucuslike covering. Numerous altered cells were present in all 11 specimens from asymptomatic contact lens wearers. The number of these cells found by conjunctival biopsy of the hard contact lens wearers and the number in the soft contact lens wearers apparently did not differ. The upper tarsal conjunctiva in these asymptomatic contact lens wearers has an altered epithelial surface, different from that observed in normal subjects without contact lens-wearing experience and from subjects with contact lens-associated giant papillary conjunctivitis.

Adult↗

PubMed1976

Asymptomatic primary hyperparathyroidism.

With the advent of automated equipment for blood chemistry determinations, many patients are presenting with asymptomatic or "biochemical" hyperparathyroidism. In the present series, of 136 patients operated on for hyperparathyroidism, fifty-three were considered asymptomatic. In fifty-one patients, parathyroid pathologic conditions were found; in one patient, it is probable that an adenoma had been missed, and in the other, it is presumed that an error in diagnosis was made. We recommend that surgical exploration be considered as an acceptable alternative to watchful waiting for patients with asymptomatic hyperparathyroidism.

Adenoma↗

PubMed1978

Abdominal aortic aneurysms. A comparative analysis of surgical treatment of symptomatic and asymptomatic patients.

This retrospective study of 120 patients identified three separate variables that influence operative mortality in patients with abdominal aortic aneurysms. These are age, presence or absence of symptoms, and presence of three preoperative risk factors or more. Based on this study and the fact that any aneurysm may rupture without warning, we conclude that observation of good risk asymptomatic patients until symptoms occur is unjustified. Asymptomatic patients less than seventy years old can undergo abdominal aortic aneurysmectomy with minimal mortality. Carefully selected asymptomatic patients more than seventy years old can also under surgical intervention with acceptable results.

Age Factors↗

PubMed2025

A viral clonality evenness score to predict progression to adult T-cell leukaemia in asymptomatic carriers of human T-lymphotropic virus type 1 in Japan: a retrospective longitudinal cohort study.

BACKGROUND: Adult T-cell leukaemia/lymphoma (ATL) is a highly aggressive T-cell malignancy that occurs in approximately 2-7% of individuals with human T-lymphotropic virus type 1 (HTLV-1), after decades of asymptomatic infection. To address the urgent need for predictive biomarkers to identify asymptomatic carriers of HTLV-1 at high risk of progression to ATL, we aimed to evaluate viral clonality sequencing as a potential tool for risk stratification. METHODS: This retrospective longitudinal cohort study involved HTLV-1 carriers enrolled in the Joint Study on Predisposing Factors of ATL Development, a nationwide cohort study initiated in Japan in 2002. Participants were selected from this cohort on the basis of their baseline proviral load at the time of enrolment as an asymptomatic carrier, length of follow-up, and clinical outcome. The cohort was subdivided into three subgroups: the first comprising HTLV-1 carriers who developed ATL, the second comprising carriers with high proviral load (≥4%) who did not progress to ATL, and the third comprising carriers with low proviral load (<4%) who did not progress to ATL. DNA extracted from peripheral blood mononuclear cells collected at enrolment and at least one follow-up visit was analysed by HTLV-1 clonality sequencing and the proviral load was quantified. We calculated a viral clonality evenness (VCE) score, based on the Shannon Evenness Index, to quantify the uniformity of the clonal distribution of samples, for which 0 represents a perfectly monoclonal architecture and 1 indicates a completely polyclonal landscape. We then estimated the performance of proviral load thresholds and VCE scoring to classify the risk of progression to ATL using the area under the receiver operating characteristic curve (AUC), the accuracy, and Matthews correlation coefficient. VCEs were compared between participant subgroups with the Wilcoxon rank sum test. FINDINGS: 56 participants followed up by JSPFAD between Feb 6, 2003, and July 19, 2022, were included in this study: 17 who progressed to ATL (mean follow-up 8·3 years [SD 4·0]), 18 who had a high proviral load and did not progress to ATL (9·7 years [3·4]), and 21 who had a low proviral load and did not progress to ATL (7·5 years [3·0]). Clonality sequencing of samples from 39 participants who did not progress to ATL revealed hundreds to thousands of HTLV-1 integration sites at both timepoints, corresponding to multiple clones of low and uniform abundance, and these participants had high VCE scores (≥0·694) at baseline. By contrast, most participants (14 of 17) who progressed to ATL had a single predominant clone or two to four predominant clones at both timepoints, and lower VCE scores (<0·694) at baseline than those who did not progress (p<0·0001). AUCs were very similar for proviral load thresholds (91 [95% CI 80-98]) and VCE scoring (91 [78-100]), although when using methods that give equal weight to every individual, VCE scoring outperformed proviral load thresholds in predicting progression to ATL (accuracy: proviral load 0·76 [95% CI 0·76-0·77], VCE scoring 1·00 [0·99-1·00]; Matthews correlation coefficient: proviral load 0·23 [95% CI 0·19-0·24], VCE scoring 0·91 [0·80-1·00]). Prediction based on VCE scoring indicated no false positives, compared with 20% when using proviral load, although VCE scoring yields a greater number of false negatives (0·3% vs 0·1%). INTERPRETATION: The implementation of VCE scoring in clinical practice could inform early pre-emptive therapeutic interventions, exclusively targeting individuals with HTLV-1 at high risk and aiming to prevent progression to aggressive, treatment-refractory disease. Further validation, including independent confirmation of the performance of VCE scoring in multiple populations and the characterisation of its temporal dynamics, will be crucial to determine its clinical utility and potential integration into care pathways. FUNDING: Association Jules Bordet, FNRS-Télévie, FCC, WALInnov, FLF, JSPS-KAKENHI, and CoBiA.

Humans↗

PubMed1977

Transient asymptomatic S-T segment depression during daily activity.

The significance of asymptomatic episodes of ischemic type S-T segment depression was studied in 20 patients with coronary heart disease. Continuous 10 hour electrocardiographic recordings accompanied by detailed daily diaries of activity and symptoms were obtained periodically during a mean time of 16 months. All patients had ischemic type S-T depression associated with angina pectoris during treadmill exercise. Measurements of heart rate, S-T depression and exercise level at the onset of angina obtained during repeated controlled exercise tests at the start of each study period were compared with the measurements recorded during daily activity. After 2,826 hours of recording, 411 transient epidsodes of ischemic type S-T depression were noted during usual daily activity. Only 101 (25 percent) of these episodes were associated with angina. The remaining episodes were unrelated to other symptoms or to posture. All occurred at heart rates significantly lower than those observed at the onset of angina during exercise testing. Of these episodes of asymptomatic S-T depression, 72 percent occurred only at rest or during very light activity such as slow walking or sitting. Nitroglycerin administered hourly significantly reduced the frequency of these episodes, thus supporting the concept that they represent painless ischemia. Because the episodes of asymptomatic ischemic type S-T depression occurred more frequently than angina during usual daily activity and were evident at heart rates and activity levels well below those expected to evoke ischemia, they may be caused by factors other than those that cause angina.

Activities of Daily Living↗

PubMed1978

Asymptomatic bacteriuria in schoolgirls. VIII. Clinical course during a 3-year follow-up.

A 3-year follow-up of 116 schoolgirls with asymptomatic bacteriuria, treated or untreated is reported. It is concluded that bacteria isolated from girls with asymptomatic bacteriuria do not commonly cause symptomatic pyelonephritis and that the risk of developing renal damage as a result of asymptomatic bacteriuria in a schoolgirl with a roentgenographically normal urinary tract seems to be small. It is also suggested that for the majority of these patients therapy is not necessary.

Adolescent↗

PubMed1979

Adhesiveness to urinary tract epithelial cells of fecal and urinary Escherichia coli isolates from patients with symptomatic urinary tract infections or asymptomatic bacteriuria of varying duration.

Adhesiveness to human urinary tract epithelial cells was high for Escherichia coli strains isolated from patients with acute pyelonephritis and acute cystitis, and low for asymptomatic bacteriuria strains detected at screening. Escherichia coli bacteria causing asymptomatic reinfections, detected near the onset of bacteriuria, adhered more than those detected at screening. No difference in the adhesive ability was found between fecal isolates of the strain causing urinary tract infection, isolated at or before onset of bacteriuria, and the urinary strain in symptomatic or asymptomatic patients. Normal fecal Escherichia coli from non-bacteriuric patients adhered less than all other strains tested.

Adhesiveness↗

PubMed1977

Tubular function impairment in patients with asymptomatic hyperuricemia.

Renal function studies were done on asymptomatic hyperuricemic subjects and normouricemic controls matched as to age, sex and blood pressure. Abnormal urinary sediments and proteinuria were found more frequently in asymptomatic hyperuricemic subjects than in the controls. In addition, the maximal osmolar concentrating ability of urine was markedly reduced in the asymptomatic hyperuricemic subjects. There was no difference in renal function measured by phenolsulfonphthalein excretion between the groups. Our results suggest that hyperuricemia alone may contribute to renal tubular impairment.

Adult↗

PubMed1979

Leber's optic neuropathy: a clinical and visual evoked potential study of affected and asymptomatic members of a six generation family.

Fourteen clinically affected and 40 asymptomatic members of a six generation family with Leber's optic neuropathy have been studied clinically and by recording pattern-reversal visual evoked potentials. While 12 of the affected members had suffered the typical sequential bilateral failure of vision, in 2 the condition was still monocular after periods of 12 and 14 years. Reduced vascularity of the optic nerve head was found in 11 of these cases, all of whom had some degree of optic atrophy, and showed a significant correlation with the visual acuity. Excessive tortuosity of peripheral retinal vessels was noted in 6 cases and was a prominent feature in the unaffected eye of one of the subjects with monocular visual impairment. In cases with advanced visual impairment the VEP was absent bilaterally, while in those with less severe involvement responses which were delayed, desynchronized and much small than normal could still be recorded. Two subjects with early bilateral clinical involvement had normal or minimally abnormal responses. Repeat studies in 6 subjects after intervals of up to fifteen months showed no change in 4 and a deterioration in 2. It is concluded that the VEP findings in clinically affected subjects are in keeping with a severe demyelinating lesion of the optic nerve with associated nerve fibre loss. Mild impairment of colour vision, pallor or reduced vascularity of the optic nerve head, excessive tortuosity of retinal vessels, a small central scotoma, and/or mild abnormalities or atypical features of the VEP were found in 16 of the 40 asymptomatic family members studied. Such abnormalities were present in 50 per cent of descendants from the female lineage who were at risk of developing the disease, and also in 30 per cent of descendants from male lineages who were not at risk. These findings suggest that there is a stage prior to the onset of visual impairment during which subtle abnormalities may be detected in individuals at risk of developing or transmitting the disease. The finding of asymptomatic abnormalities in descendants from male lineages could be accounted for by transmission of a partial form of the disease by affected or unaffected males, which would be in accord with a cytoplasmic mechanism of transmission for the disease.

Adolescent↗