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PubMed2002

Incidence and short-term outcome of children with symptomatic presentation of organic acid and fatty acid oxidation disorders in Germany.

OBJECTIVE: To determine the incidence of symptomatic children with inherited organic acid disorders (OADs) and fatty acid oxidation disorders (FAODs) in Germany. METHODS: An active surveillance of symptomatic children with inherited OADs and FAODs was conducted during a time period of 24 months (1999-2000) in Germany. Monthly inquiries were sent to all Departments of Pediatrics by the German Pediatric Surveillance Unit (ESPED) and quarterly to all specialized metabolic laboratories. Newly diagnosed patients were added to the database, recording clinical and biochemical information via a standardized questionnaire. RESULTS: Prospective surveillance enrolling 844 575 children identified a total of 57 symptomatic children with newly diagnosed OADs or FAODs in states with conventional neonatal screening, resulting in an estimated cumulative incidence of 1:14 800. The most frequent diagnosis among these children was medium-chain acyl-CoA dehydrogenase deficiency (n = 20). The majority of symptomatic children revealed clinical symptoms during the first year of life (n = 36), frequently presenting with acute metabolic crises (n = 31). Eight children died during these crises. Notably, 47 of the symptomatic children suffered from diseases potentially detectable by expanded neonatal screening programs. This subgroup included 29 children presenting with metabolic crises and 7 of the 8 deaths. CONCLUSIONS: Despite increased clinical awareness of OADs and FAODs, the mortality and morbidity for these children remains high, if they are diagnosed after manifestation of clinical disease. An introduction of nationwide neonatal screening programs would change the focus for organic acid analysis from patients presenting with acute metabolic crises to more chronic clinical presentations, especially the cerebral organic acid disorders.

3-Hydroxyacyl CoA Dehydrogenases↗
PubMed2005

Neonatal cytomegalovirus blood load and risk of sequelae in symptomatic and asymptomatic congenitally infected newborns.

OBJECTIVE: Human cytomegalovirus (CMV) is a ubiquitous human-specific DNA virus and is the main cause of congenital virus infection in developed countries leading to psychomotor impairment and deafness. Diagnostic techniques for CMV detection have greatly improved during recent years with the advent of sophisticated serological and virological methods. The aim of the present study was to assess the diagnostic and prognostic value of detection and quantification of virus in neonatal blood samples of symptomatic and asymptomatic newborns with CMV congenital infection. METHODS: Between January 1997 and December 2003, we studied 99 newborns who were born to women with primary, recurrent, and undefined CMV infection during pregnancy. CMV congenital infection was identified by isolation of the virus in urine within the second week of life. Fifty-eight of 99 infants were infected and were assessed clinically for disease in the newborn period and classified as having symptomatic or asymptomatic infection on the basis of physical, instrumental, and laboratory findings. The infants were followed up from birth according to a protocol of the tertiary NICU at the University of Bologna in a prospective study of long-term sequelae of congenital infection. Forty-seven blood samples were obtained from 47 infants in the neonatal period: 34 were examined for pp65 antigenemia test and 44 for qualitative and quantitative polymerase chain reaction (PCR and qPCR). Sequelae at 12 months were evaluated in a group of 50 infants. RESULTS: Antigenemia was positive in only 10 of 34 samples of infected newborns (29.4% sensitivity). PCR was performed in 44 samples of infected newborns and was positive in all (100% sensitivity). qPCR showed a finding of > or =100 copies per 10(5) of polymorphonuclear leukocytes (PMNLs) in 39 of 44 samples; in the other 5 cases, the number of copies per 10(5) PMNLs was <100. Between symptomatic and asymptomatic newborns, the mean values of viral blood load determined by qPCR turned out to be significantly higher in symptomatic newborns. Mean values of neonatal blood viral load were statistically higher in newborns who developed sequelae than in those who did not. Of 20 children with a neonatal viral blood load of <1000 copies per 10(5) PMNLs, 19 did not develop sequelae (negative predictive value: 95%), whereas 2 of 3 with a viral blood load of >10,000 copies did develop sequelae. CONCLUSIONS: Different viremia value ranges are correlated to a different risk of sequelae: approximately 70% sequelae were found in newborns with a qPCR higher than 10,000 copies per 10(5) PMNLs. Low neonatal viral blood load detected by pp65 antigenemia test and qPCR was highly predictive of absence of sequelae: DNAemia <1000 copies per 10(5) PMNLs has a negative predictive value of 95%. As an independent predictive factor of outcome, neonatal viremia is another useful element for neonatal counseling and therapeutic choices in symptomatic and asymptomatic newborns.

Central Nervous System Diseases↗
PubMed2005

[Systemic hypertension at emergency units. The use of symptomatic drugs as choice for management].

OBJECTIVE: Compare the therapeutic response of symptomatic, hypertensive patients to symptomatic medication or anti-hypertensive drugs at the Emergency Unit. METHODS: A randomized, blind clinical trial involving 100 (one hundred) patients assisted at the Cardiology Emergency Unit at Oswaldo Cruz University Hospital (HUOC). All patients reported symptoms associated to systolic pressure (SBP) between 180 and 200 mmHg and/or diastolic pressure (DBP) between 110 and 120 mmHg. Patients were randomized for treatment with symptomatic (dipirone or diazepan) or anti-hipertensive drug (captopril). Those reporting any associated clinical condition and in need of immediate treatment at the Emergency Unit were excluded from the study. Patients reporting no symptoms, and systolic pressure reduced to levels under 180 mmHg and diastolic pressure under 110 mmHg after the 90-minute period were considered as having met discharge criteria. RESULTS: Mean age of population studied was 54.4 years old, most commonly females. Patients were chronic hypertensive, on irregular pharmacological treatment, with low compliance to non-pharmacologic actions, and classified as overweight and obese grade I. Headache, type D (non-angina) chest pain, and dyspnea were the most frequent complaints. The number of patients treated with symptomatic drug who reached discharge criteria was similar to that of patients treated with anti-hypertensive (p=0.165). No association was found between previous high blood pressure (HBP) diagnosis (p=0.192), pharmacological treatment (p=0.687), and non-pharmacological treatment and discharge criteria. CONCLUSION: Blood pressure (BP) was reduced below levels for discharge criteria for a (non-significant) higher rate of patients treated with symptomatic drug, who were turned into asymptomatic after the observation period.

Adult↗
PubMed1989

[Asymptomatic and symptomatic Rathke's cleft cysts. Histological study of 45 cases].

Pituitary cysts are fairly often found incidentally in anatomical studies, but symptomatic cysts are relatively uncommon. In this study, the histological characteristics of 42 asymptomatic and three symptomatic Rathke's cleft cysts were examined and compared. The 42 cysts found incidentally at autopsy were classified as small (less than 1 mm in diameter), medium (1 to 5 mm), or large (over 5 mm). There were 23 small (55%), 13 medium (31%), and six large (14%) cysts. The mean ages of the three patient groups were 66, 60, and 53 years, respectively. Flattened epithelial cells were the most common cells in small cysts, while cuboidal to columnar epithelial cells were more prevalent in medium and large cysts. The larger cysts tended to contain cilia. The three symptomatic cysts were histologically confirmed to be Rathke's cleft cysts by their characteristic ciliated columnar epithelial lining. No essential histological differences were observed between asymptomatic and symptomatic cysts, and the mechanism of change from asymptomatic to symptomatic Rathke's cleft cyst was not clarified. Small nests of epithelium at the junction of the pars tuberalis and pituitary stalk are considered to be remnants of Rathke's pouch and are thought to give rise to craniopharyngioma. In their most typical forms, Rathke's cleft cysts and craniopharyngiomas are histologically distinguishable, craniopharyngiomas being composed of stratified squamous epithelium and simple Rathke's cleft cysts of a layer of cuboidal or columnar epithelium on a basement membrane.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed2000

Morton's neuroma: is it always symptomatic?

OBJECTIVE: We determined the prevalence of clinically silent Morton's neuroma and searched for distinguishing MR imaging features of Morton's neuroma in patients with clinical complaints related to this entity and in patients with clinically silent lesions. MATERIALS AND METHODS: One radiologist who was unaware of clinical findings retrospectively reviewed 85 consecutive foot MR examinations. MR imaging criteria for Morton's neuroma included a low- to intermediate-signal-intensity soft-tissue mass in the intermetatarsal space. The size, location, and signal intensity of each neuroma and the presence of intermetatarsal bursae were recorded. The patients were subdivided into symptomatic or asymptomatic groups on the basis of the patients' answers on a questionnaire documenting the locations and characteristics of symptoms and discussions with each referring physician about clinical findings. Surgical confirmation was available in eight of 25 symptomatic patients. RESULTS: The prevalence of Morton's neuroma in patients with no clinical evidence of this condition was 33% (19/57). Twenty-five patients had symptomatic Morton's neuroma, 19 had Morton's neuroma based on MR imaging findings with no clinical manifestations, and 41 did not have Morton's neuroma. Slightly larger lesions were observed in the symptomatic group, although significant overlap was noted between the two groups. The mean transverse diameter of symptomatic neuromas was 5.3 mm (standard deviation, 2.14) compared with 4.1 mm (standard deviation, 1.75) for asymptomatic neuromas; this difference was marginally significant (p = 0.05). CONCLUSION: The MR imaging diagnosis of Morton's neuroma does not imply symptomatology. Careful correlation between clinical and MR imaging findings is mandatory before Morton's neuroma is considered clinically relevant.

Adolescent↗
PubMed2006

Assessment of symptomatic patients after endoscopic sinus surgery with special reference to the frontal sinus: comparative radiologic analysis.

PURPOSE: To reveal the role of potential risk factors in frontal recess dissection (FRD), middle turbinate resection (MTR), sinonasal polyposis, and extension of disease in postoperative frontal sinus opacification by determining radiologic changes after endoscopic sinus surgery (ESS) in symptomatic cases using computed tomography (CT). STUDY DESIGN: Retrospective analysis of prospectively collected data from symptomatic patients after ESS. METHODS: Postoperative CT scans were taken in all symptomatic patients during their least symptomatic period or after maximal medical therapy. The radiologic findings of each sinus were compared, and the outcome of ESS was statistically evaluated. Furthermore, FRD, MTR, sinonasal polyposis, and extension of disease were analyzed for postoperative frontal sinus opacification. RESULTS: In our study, 101 sinuses of 61 symptomatic patients were examined. A significant improvement in opacification in all sinuses was detected postoperatively. Multivariate analysis of all potential risk factors revealed that postoperative frontal sinus opacification was affected only by sinonasal polyposis (odds ratio [OR] 3.32; 95% confidence interval [CI] 1.04-10.58) and extension of disease (OR 16.93; 95% CI 4.33-66.23). CONCLUSIONS: Our study revealed that surgical procedures such as FRD and/or MTR may not directly affect postoperative frontal sinus opacification. On the contrary, sinonasal polyposis and extension of disease seemed to be the main risk factors of this issue.

Adolescent↗
PubMedDate not supplied

Outcome of endovascular treatment in symptomatic intracranial vascular stenosis.

OBJECTIVE: The outcome evaluation for the revascularization of intracranial vascular stenoses has not been fully described due to the highly technical nature of the procedure. We report here on the early and late clinical outcomes of angioplasty and/or stenting of symptomatic severe intracranial vascular stenoses at a single institute. MATERIALS AND METHODS: Since 1995, we have treated 35 patients with symptomatic intracranial vascular stenosis (more than 70% stenosis, mean stenosis: 78.6%+/-6.2%). Angioplasty (n = 19) was performed for the horizontal segment of the middle cerebral artery (M1) (n = 16) and the basilar artery (BA) (n = 1), the intradural vertebral artery (VA) (n = 1), and the cavernous internal carotid artery (ICA) (n = 1). Stenting (n = 16) was performed for the cavernous or petrous ICAs (n = 9), the intradural VA (n = 3), BA (n = 2), and M1 (n = 2) artery. We assessed the angiographic success (defined as residual stenosis < 50%) rate, the periprocedural complications during the 30-day periprocedural period, the symptomatic recurrence and restenosis during a mean 22-month follow-up (FU) period. The Kaplan-Meier estimate of the cumulative event-free rate of the major cerebrovascular events, i.e. death, stroke or restenosis, was also done. RESULTS: Angiographic success was achieved in 97% of our patients (34/35). There were four procedure-related complications (11%) including a death and a minor stroke. During the mean 22-month FU, the asymptomatic restenosis rate was 9% and the symptomatic restenosis rate was 6% in the target lesion and 9% in all the vascular territories. The Kaplan-Meier estimate was 70.6% (95% confidence interval = 46.5-94.7) after 33 months of FU. CONCLUSION: In addition to a high angiographic success rate and an acceptable periprocedural complication rate, intracranial angioplasty and/or stenting revealed a relatively low symptomatic recurrence rate. Hemorrhage is a rare, but the physician must aware that potentially fatal periprocedural complications can occur.

Adult↗
PubMed1991

[Clinical studies of bacteriuria in renal transplantation recipients. Correlation with pyuria and symptomatic genitourinary tract infection].

The clinical state of bacteriuria and its correlation with pyuria and symptomatic genitourinary tract infection (GUTI) were studied in 42 renal transplantation recipients who were followed up in the Kidney Center of Tokyo Women's Medical College over 6 months and who showed bacteriuria more than 3 times between January and December in 1987. The results were as follows. 1) Of the 42 recipients, bacteriuria was found less than 5 times in 19 patients, 6 to 10 times in 18 patients and more than 11 times in 5 patients. There was a tendency for the same bacteria to be isolated several times from the same patient. The most commonly isolated bacterias were Enterobacter, Enterococcus, Serratia and E. coli. 2) Bacteriuria was accompanied by pyuria in 33 patients (79%) and by symptomatic GUTI in 12 patients (29%). Bacteriuria without pyuria was shown in 9 patients (21%) without symptomatic GUTI and it was suggested that bacteriuria did not result in graft hypofunction after two years. 3) Of 16 patients with bacteriuria accompanied by pyuria, symptomatic GUTI occurred in 9 patients (56%). Of these, one patient was found to have VUR of the transplanted kidney, another was found to have VUR of the native kidney, and a third patient died due to interstitial pneumonitis presumably as a result of overimmunosuppression. Transplantation recipients with bacteriuria accompanied by pyuria develop symptomatic GUTIs frequently and should be treated with proper antibacterial agents. When bacteriuria continues, further examination should be performed for an organic disease of the urinary tract or an overimmunosuppressed state. When a patient shows bacteriuria without pyuria, chemotherapy is not needed and it is sufficient to observe the course carefully.

Adult↗
PubMed2002

Ultrasonographic evaluation of plantar fascia bands. A retrospective study of 211 symptomatic feet.

The authors measured the thickness of the medial, central, and lateral bands of the plantar fascia using ultrasonographic techniques in 109 symptomatic patients with 211 painful heels. Plantar fasciitis was diagnosed by the presence of plantar heel pain and tenderness of the plantar fascia on palpation and was correlated with plantar fascia thickness. All of the symptomatic feet had medial band tenderness, with an average thickness of 5.9 mm, 68% had central band tenderness, with an average thickness of 5.3 mm, and 26% had lateral band tenderness, with an average thickness of 4.4 mm. The average thickness of all symptomatic bands was 5.35 mm, which was significantly greater than that for all asymptomatic bands, which was 2.70 mm. There were also significant differences in the thickness of the three plantar fascia bands in symptomatic patients. A plantar fascia index was established consisting of the ratio of the mean thickness of symptomatic medial, central, and lateral plantar fascia bands to that of asymptomatic bands; for this study, the index value is 1.98 (5.35/2.70 mm).

Adolescent↗
PubMed1999

Prospective study of alcohol consumption patterns in relation to symptomatic gallstone disease in men.

Although the association between alcohol intake and gallstone disease has been characterized previously, the relation between alcohol consumption patterns, specific types of alcoholic beverages, and risk for cholelithiasis has not been addressed systematically. These issues were examined prospectively in a cohort of men who were free from symptomatic gallstone disease in 1986 and were followed to 1996. During follow-up, 2.4% of the men reported newly symptomatic gallstones that were diagnosed by ultrasonography or x-ray, or a cholecystectomy. After adjusting for other known or suspected risk factors, an increase in the amount of alcohol consumed was associated with a decreased risk of symptomatic gallstone disease. An increase in frequency of alcohol consumption also was related to decreased risk. Combining the reports of quantity and frequency of alcohol intake, a consumption pattern that reflected frequent intake (5-7 days/week) of any given amount of alcohol was associated with a decreased risk, as compared with nondrinkers. In contrast, infrequent alcohol intake (1-2 days/week) showed no significant association with risk. All alcoholic beverage types were inversely associated with risk of symptomatic gallstone disease, independent of patterns of consumption. These results suggest that frequent, moderate intake of alcohol decreases the risk for symptomatic gallstone disease, in contrast to infrequent or episodic alcohol intake. Recommendations regarding the benefit of moderate quantities of alcohol for gallstone discase should be weighed against the potential health hazards of alcohol consumption.

Adult↗
PubMed2000

[Frequency of colicin and hemolysins in Escherichia coli isolated from pregnant patients with urinary tract infection, symptomatic and asymptomatic].

Colicin production was studied among 137 Escherichia coli strains isolated from pregnant patients with symptomatic or asymptomatic, urinary tract infection (IVU). The observed colicinogeny frequency was 72.92% (n = 96), among the symptomatic patients and 29.26% (n = 41) among the asymptomatic group. The most frequently identified colicins from symptomatic patients were: V (23.9%), A (18.7%) and E1 (17.7%) and within the patients with asymptomatic IVU the most frequently observed colicins were A (9.7%), E1 (17.0%) y V (2.4%). The major frequency of colicin V among the E. coli strains isolated from the symptomatic group against the asymptomatic one, was statistical significant (p > or = 0.025). The results on the observed frequencies of colicins E1 and A were not statistical significant. Among the 137 studied E. coli strains, 37.2% were hemolytic. 83.3% of the colicin V producing strains (n = 24) were hemolytic, among the strains producing other colicin different than colicin V 34% (n = 58) were hemolytic and 12.0% of non colicinogenic strains were hemolytic. These results were statistical significant (p > 0.05). The present data, suggest that colicins production is an important pathogenicity factor among the E. coli strains, specially for those strains producing colicin V. The observed association among hemolysin and colicin V production may be an interesting pathogenicity factor which suggests an increasing ability of uropathogenic strains to produce symptomatic urinary tract infections.

Colicins↗
PubMed2000

Effect of atenolol on symptomatic ventricular arrhythmia without structural heart disease.

Ventricular arrhythmia (VA) from right ventricular outflow tract (RVOT) is a common problem. Symptomatic patients are usually treated with beta-blockers. There is little data on the systematic evaluation of the drug efficacy. The objectives of this study were 1) To determine proportion of exercise induced ventricular arrhythmia among patients with symptomatic ventricular arrhythmia and 2) to determine the response to beta blockers and the correlation between the response to betablockers and exercise induced VA. We prospectively studied 46 consecutive patients with symptomatic ventricular arrhythmia. Patients recorded their symptom scores underwent exercise testing and 24-hour ambulatory monitoring before treatment and 1 month after atenolol. Exercise induced ventricular arrhythmia was demonstrated in 28 per cent of patients with symptomatic ventricular arrhythmia. Atenolol improves symptoms, decreases PVC count from ambulatory monitoring, increases exercise duration and suppresses malignant form of VA during exercise. These effects are at a similar extent in both groups of patients: those with and without exercise induced VA. However, the effect on ventricular arrhythmia suppression during exercise of atenolol was seen only in patients with increased PVC during exercise. In conclusion, atenolol is a good option in treating patients with symptomatic VA from RVOT regardless of the pattern of PVC response to exercise. Atenolol can suppress PVC during exercise testing better in patients with exercise induced VA compared to those without.

Adult↗
PubMed2001

Long-term followup after laparoscopic nephropexy for symptomatic nephroptosis.

PURPOSE: Symptomatic nephroptosis is a rare disease requiring surgical therapy only in select cases. Laparoscopic nephropexy has been reported as minimally invasive treatment for symptomatic patients. We evaluated our long-term outcome after laparoscopic fixation of the kidney with an alloplastic mesh graft. MATERIALS AND METHODS: Since 1992, 30 patients have undergone laparoscopic transperitoneal nephropexy for symptomatic nephroptosis. All patients were preoperatively investigated by excretory urography (IVP) and split renal scan in the supine and upright positions. For fixing the kidney to the abdominal wall a polyglactin and polypropylene mesh graft was used in 6 and 24 cases, respectively. A total of 17 patients with a minimum followup of 5 years participated in an assessment of long-term outcome. Clinical examination, IVP and split renal function testing were performed with patients lying and standing. Patients were further questioned about postoperative satisfaction and whether they would undergo the procedure again. RESULTS: Of 17 patients 10 completed all investigations, 3 were contacted by telephone and 4 were lost to followup. Median followup was 5.9 years. Improvement in symptoms was reported in all cases with complete relief in 11 and intermittent flank pain requiring no medication in 2. There were no postoperative urinary tract infections or hematuria observed with improved hypertension requiring no postoperative medication in 1 case. Postoperatively IVP showed no recurrence in 8 of 10 patients but there was 5 cm. or greater recurrent ptosis in 2. Recurrence developed after using the polyglactin and polypropylene mesh grafts. Comparing preoperative and postoperative (123)iodine renal scans revealed significant improvement in renal function in 9 cases (p <0.05). There was no postoperative difference in split renal function and only 1 patient did not improve. No complications were noted except 1 symptomatic recurrence 3 months after the initial operation that required open surgical fixation. A total of 11 patients were completely satisfied with the long-term outcome and 2 were moderately satisfied. Of the patients 12 would undergo the procedure again, including 2 with persistent slight flank pain. One patient was inconsistent in regard to whether she would undergo the procedure again. CONCLUSIONS: Symptomatic nephroptosis is a bothersome disease requiring therapy only after thorough evaluation, including IVP and split renal scan with patients supine and upright. The good clinical outcome and highly satisfactory cosmetic result support laparoscopic nephropexy as the treatment of choice. Short-term and long-term results prove the efficacy of renal fixation with alloplastic mesh graft as minimally invasive therapy with a high success rate.

Adult↗
PubMed2001

Area under the viraemia curve versus absolute viral load: utility for predicting symptomatic cytomegalovirus infections in kidney transplant patients.

A novel approach to predicting symptomatic cytomegalovirus (CMV) infections combines the level and the duration of viraemia in a single parameter. Sixty-four kidney transplant recipients were monitored by quantitative shell vial culture, pp65 antigenaemia, and polymerase chain reaction (PCR) of leucocytes. The area under the curve (AUC) of each parameter was determined from the onset of viraemia to the beginning of antiviral treatment. The AUC values were significantly higher in symptomatic than in asymptomatic patients. For antigenaemia and PCR, optimal AUC thresholds for predicting symptomatic CMV infections were determined. They were superior to standard cutoff levels of absolute viral load in sensitivity, specificity, and positive and negative predictive value. In 8 of the 23 patients who became symptomatic, impending clinical features were indicated earlier by the AUC thresholds than by standard viral load. In conclusion, the concept of the AUC should facilitate identification of patients at risk of symptomatic CMV infection.

Area Under Curve↗
PubMed2002

[Two cases of symptomatic arachnoid cysts in elderly patients--a comparison and analysis with child cases].

A symptomatic arachnoid cyst in an elderly patient is rare. We report two cases of symptomatic arachnoid cysts in elderly patients. The first case is that of a 73-year-old woman complaining of headache and speech disturbance. She had an arachnoid cyst in the left interhemispheric fissure. This is rare. Only two interhemispheric arachnoid cysts in the elderly have ever been reported. The other case is that of a 64-year-old woman, having right hemiparesis and dementia and a cyst is shown in her left temporal lobe. Both patients underwent a cystectomy which resulted in the disappearance of their symptoms. Only 56 cases of symptomatic arachnoid cyst over the age of 60 years have ever been reported. We made an analysis of 58 cases, including our two cases, and compared it with child cases. In cases of the elderly, the symptoms are usually headache, hemiparesis, gait disturbance and dementia, which are similar to symptoms of chronic subdural hematoma and normal pressure hydrocephalus. On the other hand, child cases usually reveal signs of intracranial hypertension. Several authors have reported their therapeutic method for child symptomatic arachnoid cysts. However, it is difficult to determine the best method for treating child cases at this time. We think a cystectomy is the first choice of operative procedure for symptomatic arachnoid cyst in the elderly.

Aged↗
PubMed1999

Diagnosis of symptomatic and asymptomatic Trichomonas vaginalis infection by applying one tube nested PCR to vaginal discharge.

One tube nested-PCR targeting a species-specific Tv-E650 repeat family of T. vaginalis genome, was applied to vaginal discharge specimen to diagnose symptomatic and asymptomatic trichomoniasis. The test was compared with axenic culture examination, wet mount preparation and Papanicolaou stained smears. Four-hundred and fifty cases symptomatic and symptomatic were collected over two years. Out of 290 symptomatic women with cervicovaginitis and 160 asymptomatic women, 35 were culture positive for trichomoniasis. All culture positive specimens were PCR-positive giving a single product at 290 bp by agarose gel electrophoresis and recording 100% sensitivity, similar to culture examination. Among the 35 culture positive specimens, 12 were positive by wet mount and 21 were positive by Pap smear giving a 34.2% and 60% sensitivity, respectively. The standard and boiling DNA extraction methods were equally reliable but the latter was more simple, rapid and cheap. No specimens negative by PCR for trichomoniasis were positive by culture, wet mount or Pap smear. Moreover, specimens from cases with cervicovaginitis of non-trichomonal origin were negative by PCR. All samples of extracted DNA of T. vaginalis from positive culture tubes, used as positive controls, were also PCR positive at the expected product in gel, while no PCR product was detected with the negative DNA control including Chylamidia trachomatis and human DNA. It was found that the one-tube nested-PCR targeting the Tv-E650 repeat family of T. vaginalis is a simple, rapid sensitive and specific accurate method for diagnosis of symptomatic and asymptomatic vaginal trichomoniasis when applied to vaginal discharge.

Adolescent↗
PubMed2003

Travel and the risk of symptomatic venous thromboembolism.

Whether long-distance travel and symptomatic venous thromboembolism (VTE) are associated is debated. On the basis of the available literature a fair risk estimate cannot be obtained. We estimated an accurate odds ratio for the relationship between recent travelling and symptomatic VTE. From three case-control studies consisting of 788 and 170 patients with clinically suspected deep vein thrombosis (DVT) and 989 patients with clinically suspected pulmonary embolism (PE) referred for diagnostic work-up, a pooled odds ratio for the relation between travel and symptomatic VTE was calculated. Cases were patients in whom the diagnosis was confirmed according to a diagnostic management strategy, whereas controls were patients in whom the diagnosis was excluded and who had an uneventful clinical follow-up. Patients were seen in the period April 1997 to September 2000. Travel history was recorded prior to diagnostic work-up. The pooled odds ratio for the association between any travel and symptomatic venous thromboembolism was 0.9 (95% CI: 0.6-1.4). The median travel time was 7 h (quartile range 4 to 10 h). Separate analyses performed for different types of transport (plane, car, bus or train) yielded comparable odds ratios. The analysis for duration of travelling showed an increased odds ratio of 2.5 (95% CI: 1.0-6.2) in the category of 10-15 h of travelling. This study shows that the average traveller does not have an increased risk for symptomatic venous thromboembolism. Only very long travelling (more than 10 h) may be associated with venous thromboembolic disease.

Adolescent↗
PubMed1999

Symptomatic and asymptomatic carotid artery lesions in peripheral vascular disease: a prospective study.

PURPOSE: To assess the incidence and severity of internal carotid artery lesions in patients who were referred to a single institution with peripheral obliterative atherosclerotic disease (POAD) as their chief complaint, in order to identify symptomatic and asymptomatic subjects at risk of stroke who would benefit from surgery. MATERIALS AND METHODS: Consecutive patients with clinically and Doppler scan-proven POAD underwent prospective screening for the presence of carotid symptomatic and asymptomatic atherosclerotic lesions with duplex ultrasound scan (DUS). Associated risk factors for atherosclerosis, i.e. age, sex, diabetes, hypertension, hyperlipidemia, history of smoking and history of coronary artery disease were assessed and recorded. Univariate analysis was performed to correlate the risk factors with the presence of POAD and carotid lesions. RESULTS: Three-hundred and twelve consecutive patients were evaluated over an 18-month period. A 30% or greater carotid stenosis was detected by DUS in 189 patients (19 bilateral); 57 (30%) of these had neurologic symptoms, 19 of whom had a 70-99% carotid lesion, whereas 65 of the 132 asymptomatic patients had 60-99% carotid stenosis. Univariate analysis revealed no differences in the symptomatic and asymptomatic groups between patients who were potential candidates for carotid endarterectomy according to the North American Symptomatic Carotid Endarterectomy Trial and the Asymptomatic Carotid Atherosclerotic Study Group guidelines, respectively, and those who were not as regards associated atherosclerotic risk factors and severity of POAD. All but 2 (n = 17) symptomatic and 18 asymptomatic patients underwent carotid endarterectomy based on DUS criteria alone. The perioperative stroke risk and mortality rates were 0%. CONCLUSIONS: Routine carotid DUS screening of 312 consecutive patients with POAD revealed that 19 patients with symptoms and 65 (5 bilateral) without symptoms would benefit from surgery, representing 27% of the series considered.

Aged↗