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Comparison of structural polypeptides, detected by immunoblotting technique, in the sera of spotted fever group rickettsia positive cases--symptomatic versus asymptomatic.

In an attempt to characterize the nature of symptomatic versus asymptomatic spotted fever group rickettsia (SFGR) infection, the immune response to R. conorii (boutonneuse fever) structural polypeptides was studied by Western-blot immunoassay. Sera from immunoperoxidase assay (IPA), SFGR seropositive (titre greater than or equal to 80) individuals, symptomatic and asymptomatic and from SFGR seronegative (IPA titre less than 80) individuals living in a kibbutz community in the desert region of Southern Israel were examined by immunoblot. This community suffered from a very high morbidity rate due to SFGR (21-fold higher than the national reported average). The entire community (n-326) has been followed-up since 1985, with serial serum samples being examined for specific IgG antibodies by IPA. The intensity of the immunoblot reaction correlated with specific IgG antibody titres as determined by IPA. This correlation was also observed between the decrease in the IgG titre and the strength of the antibody-antigen reaction by immunoblot over time for a given individual. IPA seropositive sera from asymptomatic as well as symptomatic spotted fever cases reacted to 8 individual polypeptides. In both cases antibodies to 22 kD, 24 kD, 26 kD, 28 kD, 30 kD, 32 kD, 34 kD, and 37 kD were found. In the IPA seronegative sera, antibodies to polypeptides in the range of 24 kD to 32 kD were not detected. The lack of detectable differences by immunoblotting between SFGR symptomatic vs, asymptomatic cases might be explained by other aspects of the immune response of each infected individual, and/or it is possible that virulent and non-virulent antigenically closely related SFGR strains infected symptomatic vs. asymptomatic individuals.

Bacterial Proteins↗

The association of milk consumption with the occurrence of symptomatic knee osteoarthritis.

OBJECTIVE: To evaluate the association of nutritional factors with symptomatic knee OA. METHODS: This cross-sectional study was performed face-to-face using a structured interview. Individuals who had a diagnosis of symptomatic knee OA and were aged 50 years or over were included in this study. The frequency of consumption of dairy products, meat/poultry, fish, cereals, vegetables, tea and coffee were also determined. The diagnosis of knee OA was made clinically or clinically and radiologically according to the ACR criteria for knee OA. RESULTS: A total of 655 subjects was interviewed. The frequency of symptomatic knee OA was significantly lower in daily milk consumers (p < 0.05). Tea consumption was also inversely associated with symptomatic knee OA (p < 0.05), although other nutritional elements showed no significant relationship with OA. CONCLUSION: Milk consumption may have beneficial effects on symptomatic knee OA.

Aged↗

[Therapeutic and prophylactic role of mesalazine (5-ASA) in symptomatic diverticular disease of the large intestine. 4 year follow-up results].

In order to evaluate the efficacy and tolerability of mesalazine (5-ASA) in the prophylaxis of symptomatic relapses, of major complications and of microhemorrhagic phenomena in diverticular disease of the large intestine (MDC), prospective clinical study was conducted on patients with light-moderate symptomatic MDC under treatment with sulbactam-ampicillin 1.5 g/12 h i.m. and rifaximine 400 mg/12 h per os for 7 days. Follow-up period of 5 years with seriated checkups and laboratory and instrumentation controls. End points are represented by the relapse on inflammation and/or by the occurrence of major complications. On enrollment, 166 patients were randomized to receive mesalazine (Pentacol tablets--SOFAR S.p.A.) 400 mg b.i.d. per os for 8 weeks (81 patients; group M) or no supplementary treatment (85 patients; group C). After 4 years of follow-up, 44 patients dropped out of the study (9 because of major complications, 3 for massive hemorrhage, and 32 drop outs). Symptomatic relapses occurred in 51 patients (12 M; 39 C), while minor diverticular hemorrhages occurred in 43 patients (12 M; 31 C), with an estimated probability of remaining free respectively from symptomatic relapse (p=0.00005) and from microhemorrhagic phenomena (p=0.001) decisively in favor of the group treated with mesalazine. The duration of abdominal pain due to diverticolitis was also shorter in patients of group M (p=0.0002), while the incidence of major complications and side effects was comparable in the two groups. In conclusion, supplementary treatment with mesalazine in patients affected with MDC--at a follow-up limited to 48 months--proved to be well tolerated and effective in reducing the frequency of symptomatic relapses and microhemorrhagic phenomena and in reducing the duration of abdominal pain.

English Abstract↗

Oral ibuprofen prophylaxis for symptomatic patent ductus arteriosus of prematurity.

BACKGROUND: The oral suspension form of ibuprofen has been shown to have the same efficacy and safety as indomethacin in the treatment of symptomatic PDA, however its role is still questionable in the prophylaxis of symptomatic PDA. OBJECTIVES: 1. To assess the efficacy and safety of the drug in the prevention of symptomatic PDA in premature infants. 2. To study its pharmacokinetics-pharmacodynamics relationship. MATERIAL AND METHOD: A randomized, single-blinded, controlled study was performed on premature neonates with a gestational age between 28-32 weeks, birthweight < or = 1500 grams at the neonatal unit, Queen Sirikit National Institute of Child Health from July 2003 to April 2004. Three doses of ibuprofen suspension or placebo were given 24 hours apart. Clinical evaluation was performed daily until the 28th day of life. Echocardiogram was performed prior to the drug administration, on the 3rd and 7th day of life. RESULTS: There were 22 and 20 cases in the ibuprofen and control group respectively. The epidemiologic data between the groups before enrollment showed no significant differences. Prevalence of symptomatic PDA was lower in the ibuprofen than in the control group without any significant side effects (0/22 vs 5/20, p = 0.015 on day 3 and 0/22 vs 6/20, p = 0.006 on day 7). Comparing with the pharmacokinetic study in older children and adult, the present study revealed nearly the same Cmax but longer Tmax and T1/2 in premature neonates. CONCLUSION: Oral ibuprofen suspension could reduce the prevalence of symptomatic PDA without any significant side effects.

Cyclooxygenase Inhibitors↗

[Results of the surgical treatment for symptomatic mesoacromion].

OBJECTIVES: Functional results of patients who were operated on for symptomatic meso os acromiale were retrospectively evaluated. METHODS: The study included six patients (5 females, 1 male; mean age 58.5 years; range 51 to 64 years) who underwent surgical treatment for symptomatic os acromiale following unsuccessful conservative treatment. Internal fixation and bone grafting were performed in all the patients. Evaluations were based on physical assessment, radiographic examination, and the UCLA (University of California at Los Angeles) score. All the patients had symptoms of subacromial impingement accompanied by various degrees of rotator cuff tears. Symptomatic os acromiale was diagnosed by imaging studies and tenderness over the acromion during palpation. In case of suspected stability of the acromion, arthroscopy was performed. Fixation was performed with cannulated screws (n=4) or K-wires (n=2) and a cerclage wire or nonabsorbable sutures. Bone graft was harvested locally. The mean follow-up period was 29 months (range 18 to 35 months). RESULTS: The mean UCLA score increased from a preoperative 11.8 to postoperative 28.2. Union was achieved in four patients in whom cannulated screws were used. Two patients who were fixed with K-wires remained ununited. CONCLUSION: It is possible to obtain satisfactory results with cannulated screws which probably enable a more rigid fixation in symptomatic os acromiale. Arthroscopic evaluation may be helpful in deciding whether or not os acromiale is symptomatic.

Acromion↗

Relevant sonographic parameters of a painful shoulder in symptomatic dialyzed patients versus asymptomatic dialyzed and healthy volunteers.

The aim of this study is to find dialysis relevant sonographic parameters of painful shoulder of the symptomatic dialyzed patients comparing them with parameters in asymptomatic dialyzed patients and healthy volunteers. Significant difference in all metric parameters (thickness of supraspinatus tendon, diameter of biceps tendon sheet and capsula-bone distance) were noticed between all groups and the symptomatic had the highest values. Asymptomatic had the higher values then volunteers. Inhomogenicity of the tendon and biceps tendon sheet effusion in the symptomatic patients were the most often occurred. Subdeltoid effusion, deposits and tendon rupture were found only in symptomatic patients. No difference in presence of calcifications between symptomatic and asymptomatic was found. Metric parameters are relevant and associated with dialysis, as well as biceps tendon effusion tendon inhomogenicity, deposits and subdeltoid effusion. Tendon ruptures are relatively rare and nonspecific.

Analysis of Variance↗

[Symptomatic hypersomnia due to orexin deficiency in hypothalamic lesions].

Narcolepsy is characterized by excessive daytime sleepiness (EDS), cataplexy and other abnormal manifestations of REM sleep. Recently, it was discovered that the pathophysiology of idiopathic narcolepsy-cataplexy is linked to orexin ligand deficiency in the brain and cerebrospinal fluid. Orexin neurons localize in the posterior hypothalamic area, which was previously described as "waking center" by von Economo in 1920s. Hypersomnia due to orexin ligand deficiency can also occur during the course of other neurological conditions, such as hypothalamic tumor, encephalopathy and demyelinating disorder (i.e. symptomatic hypersomnia). We experienced 8 pediatric cases with symptomatic hypersomnia. These cases were diagnosed as brain tumor (n = 2), head trauma (n = 1), encephalopathy (n = 1), demyelinating disorder (n = 3) and infarction (n = 1). Six pediatric cases with orexin measurements from the literatures were additionally included and total 14 cases were studied. Although it is difficult to rule out the comorbidity of idiopathic narcolepsy in some cases, a review of the case histories reveals numerous unquestionable cases of symptomatic hypersomnia. In these cases, the occurrences of the hypersomnia run parallel with the rise and fall of the causative diseases. Most of symptomatic hypersomnia cases show both extended nocturnal sleep time and EDS consisting of prolonged sleep episodes of NREM sleep. The features of nocturnal sleep and EDS in symptomatic hypersomnia are more similar to idiopathic hypersomnia than to narcolepsy.

Adolescent↗

Neurodevelopmental outcome of asymptomatic & symptomatic babies with neonatal hypoglycaemia.

A total of 107 babies with hypoglycaemia were studied over a period of 15 months. Symptomatic hypoglycaemia was found in 43 while it was asymptomatic in the others. Asymptomatic hypoglycaemia occurred at a relatively earlier post-natal age (4.5 +/- 2.2 h), as compared to symptomatic hypoglycemia (18.5 +/- 5.4 h, P less than 0.001). The mean blood glucose in hypoglycaemic babies with seizures was found to be significantly lower (P less than 0.001) when compared to those with other features as well as asymptomatic ones. Hypoglycaemia lasted for a significantly longer duration in symptomatic babies as compared to those without symptoms (P less than 0.001). On neurodevelopment follow up the mental developmental index (MDI) and the psychomotor developmental index (PDI) of symptomatic babies with seizures were significantly lower (P less than 0.001) as compared to those with other features of hypoglycaemia as well as asymptomatic babies. The neurodevelopmental status of babies with symptoms other than seizures was also significantly poorer (P less than 0.001), when compared to asymptomatic hypoglycaemic babies. The duration of hypoglycaemia was directly related to the MDI (r = -0.74, y = 102.5 - 0.69x) and PDI (r = -0.81, y = 105.6 - 0.86x). This study indicates that there is a need to identify babies vulnerable to symptomatic hypoglycaemia more precisely.

Humans↗

[Does symptomatic schizophrenia exist?].

The question if there are "symptomatic schizophrenias" has been discussed since the 20s. Schizophrenic psychoses caused be definable and well known brain diseases are presented. All schizophrenic symptoms and syndromes, the first rank symptoms (K. Schneider) too, occur in somatically founded psychoses. The group of paroxysmal transition syndromes in the sense of aura prolongata (continua) and the episodic schizophrenic psychoses in psychomotor epilepsy may be a model for the schizophrenia research. Vital threatening, so-called pernicious catatonic schizophrenias are found on the basis of infectious brain diseases, sometimes only diagnosed in autopsy. Beside acute and reversible symptomatic schizophrenic psychoses there are, even if rarely, recurrent and chronic courses of symptomatic schizophrenias. That certain conditions for the developing of symptomatic schizophrenias are rarely realised, could be an explanation for their rarity. Some findings indicate that the limbic system is significant for symptomatic (and idiopathic) schizophrenic psychoses and the pre- and postpsychotic basic stages determined by dynamic and cognitive basic symptoms, which are phenomenologically very similar to aura symptoms released by stereoelectroencephalographic depth recordings (Wieser). The characteristic features of marked fluctuation, discontinuity and insteadiness of the cognitive thought, perception, psychomotor and cenesthetic phenomena do not speak against an organic brain disorder provided that the traditional process hypothesis is abandoned in favor of a neurobiochemic disorder, fluctuating on its part depending on endogenous as well as psychic-reactive factors.

Chronic Disease↗

Radionuclide imaging of asymptomatic versus symptomatic total knee arthroplasties.

Ninety-eight total knee prostheses were evaluated by roentgenograms and bone scans. Fifty-three were asymptomatic, and 45 were symptomatic. Thirteen prostheses required revision surgery. At a mean of 54 months, asymptomatic knee replacements generally showed only mild uptake in one or more zones. Only one knee had uptake equal to surrounding bone. However, symptomatic knee replacements showed significantly greater uptake in the patella, femur, and medial and lateral tibial plateau regions (Mann-Whitney two-sample rank test). Bone scans in the symptomatic group were obtained at a mean of 44 months. Excluding those patients who had revision surgery, the differences remained significant. Furthermore, symptomatic knee replacements with normal roentgenograms also had significantly greater uptake. Radiolucent lines were noted in 30% of asymptomatic patients, whereas 29% of symptomatic knees had radiolucencies. Radiolucencies were not generally associated with significantly greater uptake. Lateral release had no effect on the patellar score.

Adult↗

[Comparison of the oxygen deficit and ischemia pain threshold in patients with silent and symptomatic myocardial exercise-induced ischemia].

In 39 patients with angiographically documented coronary artery disease and silent or symptomatic myocardial ischemia under exertion it was investigated if there is a difference in forearm skeletal muscle ischemia and ischemic pain threshold. The degree of myocardial ischemia was determined by plethysmographically measured reactive hyperemia. In 12 asymptomatic and eight symptomatic patients maximal reactive hyperemia was induced by ischemic work in the forearm skeletal muscle. After termination of ischemia there was a significantly higher reactive hyperemia at 20, 90, and 180 s in the asymptomatic patients. Furthermore, nine asymptomatic and 10 symptomatic patients underwent symptom-limited ischemic work until weakness or pain developed. Under these conditions reactive hyperemia as a parameter of oxygen deficiency was higher in the asymptomatic patients. The difference was not statistically significant. There was, however, a significantly higher incidence of ischemic pain in the symptomatic patients. It can be concluded that patients with asymptomatic myocardial ischemia tolerate a higher oxygen deficit in the working forearm and have a higher pain threshold than patients with symptomatic ischemia.

Angina Pectoris↗

A structural model of stress, psychosocial resources, and symptomatic experience in chronic physical illness.

The purpose of this investigation was to test a theory-based structural model describing the relationships among psychosocial resources (strength of psychosocial attributes and basic need satisfaction), perceived stress, disease severity, and symptomatic experience in people with chronic obstructive pulmonary disease (COPD). One hundred nine subjects (58 males and 51 females) participated in the cross-sectional mail survey. Psychosocial attribute strength was a significant predictor of basic need satisfaction; basic need satisfaction was a significant predictor of perceived stress; and basic need satisfaction, perceived stress, and disease severity were significant predictors of symptomatic experience. The psychosocial attributes variable was a significant predictor of basic need satisfaction for both sexes. For males, basic need satisfaction and stress were significant predictors of symptomatic experience, while psychosocial attributes were not. For females, the psychosocial attributes variable was a significant predictor of symptomatic experience, while basic need satisfaction and stress were not. The findings suggest that psychosocial resources and perceived stress may be important factors in the symptomatic experience of adults with COPD. Males and females seem to differ in the role psychosocial attributes and basic need satisfaction play in the dynamics of the proposed model.

Adult↗

[Evaluation of ischemia by exercise stress Tl-201 myocardial SPECT in silent and symptomatic ischemia].

Forty patients with ischemic heart disease confirmed by coronary arteriography were performed Tl-201 stress myocardial scintigraphy using SPECT. Fifteen patients had anginal attack during exercise Tl-201 myocardial perfusion study (symptomatic group), and 25 patients had horizontal or downsloping ST segment depression more than 0.1 mV without angina (asymptomatic group). The washout maps were derived from circumferential profile analyses of tomographic short-axis slices, and the data were plotted as a bull's eye map. The patient's washout map was compared with the lower limit of normal (mean--2 SD), and the extent and severity scores were calculated. On visual analysis 87% (13/15) of symptomatic patients showed redistribution, while only 56% (14/25) of asymptomatic patients showed redistribution (p less than 0.05). The extent score was significantly higher in the symptomatic group than in asymptomatic group (37.2 + 23.6 vs. 19.6 + 20.8, p less than 0.05), but severity score was slightly higher in symptomatic group (56.1 + 59.4 vs. 30.0 + 54.8, NS). In conclusion, symptomatic ischemia may be more severe than asymptomatic one and the degree of ischemia may be one of the factors that determine the presence of angina during ischemia.

Adult↗

Therapeutic dilemmas in patients with symptomatic polycystic liver disease.

Most reports of the operative treatment of symptomatic polycystic liver disease (PCLD) are anecdotal or consist of only a small subset of patients in an institution's overall experience treating hepatic cysts. We have reviewed our experience with nine consecutive patients with symptomatic PCLD undergoing operative treatment from 1981 to 1987. Indications for operation include chronic abdominal pain (4 patients), cyst infection (2 patients), biliary obstruction (2 patients), inferior vena cava obstruction (2 patients), and symptomatic abdominal distention (2 patients). The average duration of symptoms leading to operation was 7.8 months. Three types of cystic disease were identified based on gross morphology: dominant cystic disease (3 patients), diffuse cystic disease (4 patients), and mixed cystic disease (2 patients). Operations to treat symptomatic PCLD included unroofing and external drainage of infected cysts (2 operations), simple unroofing (1 operation), cyst fenestration alone (4 operations) and fenestration combined with resection (3 operations). Treatment directed at principally dominant cysts (five patients) was associated with resolution of symptoms and low morbidity and mortality. Treatment directed at diffusely cystic disease (four patients) resulted in significant morbidity and mortality including three deaths. Successful surgical treatment of symptomatic patients with PCLD depends on accurate preoperative identification of patients with symptoms related to one or more dominant cysts. In this setting fenestration or simple unroofing of the dominant cyst is safe and effective treatment. By comparison, extensive fenestration with or without hepatic resection in patients with symptoms attributed to a diffusely cystic liver may be associated with unacceptable morbidity and mortality.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

Virologic and immunologic characterization of symptomatic and asymptomatic primary HIV-1 infection.

To define virologic and immunologic differences in patients with acute symptomatic and asymptomatic primary human immunodeficiency virus type 1 (HIV-1) infection, sequential plasma specimens were obtained longitudinally for 1-2 years postseroconversion from subjects with well-documented time of seroconversion. Thirteen of them had an acute symptomatic primary infection, eight subjects had asymptomatic primary infection and long-term follow-up, and 27 had asymptomatic seroconversion and short-term follow-up. Quantitative plasma HIV-1 RNA levels, CD4+ lymphocyte counts, and levels of antibodies to gp120, p66, p41, p31, p24, and p17 were measured. At the time of seroconversion, there was no significant difference in HIV-1 RNA levels and CD4+ counts between symptomatic (n = 13) and asymptomatic (n = 27) subjects. Subsequently, however, establishment of low levels of plasma HIV-1 RNA was seen significantly more frequently in asymptomatic (n = 8) than in symptomatic (n = 13) primary infection; this correlated with higher levels of some (anti-gp120 and anti-p31) anti-HIV-1 antibodies and a slower decline in CD4+ lymphocyte counts. These results indicate that immunologic control of viremia early after infection may be a critical determinant to subsequent clinical course of HIV-1 infection. They also suggest that persons with acute symptomatic primary infection may generally progress to having acquired immune deficiency syndrome (AIDS) more rapidly than people with low-grade symptoms or asymptomatic primary infection.

Acquired Immunodeficiency Syndrome↗

Symptomatic hyperlipasemia after cardiopulmonary bypass: implications for enteral nutritional support.

The incidence of pancreatitis after cardiopulmonary bypass is reported as < 0.1%. We report a milder form of pancreatitis characterized by hyperlipasemia and early intolerance to enteral nutrition without overt signs of clinical pancreatitis. A retrospective study was conducted in 72 patients who had received tube feeding. A statistically (p = 0.01) greater incidence of symptomatic hyperlipasemia was noted in post-cardiopulmonary bypass (PCPB) patients (42%, 5 of 12) than in non-PCPB patients (0%, 0 of 60). Four of the 5 PCPB patients who developed symptomatic hyperlipasemia received tube feeding into the stomach or duodenum before onset of their symptoms. The overall incidence of PCPB symptomatic hyperlipasemia during the study period was 1.3% (5 of 375). A prospective study was then carried out in 54 PCPB patients. Five patients became critically ill, and 4 of these developed symptomatic hyperlipasemia. Three of the 4 patients had received tube feeding into the stomach or duodenum before the onset of symptoms. In all cases, the symptoms of tube-feeding intolerance were mild and resolved with termination of feeding. This study suggests that critically ill cardiopulmonary bypass patients may be more susceptible to developing symptomatic hyperlipasemia, which is characterized by early intolerance to enteral nutritional support.

Cardiopulmonary Bypass↗

Intravenous immunoglobulin in symptomatic and asymptomatic children with perinatal HIV infection.

One hundred thirty-five children born to human immunodeficiency virus (HIV)-infected mothers were selected randomly to receive immunoglobulin (Gamimune-N, Miles Pharmaceutical Co) 200 mg/kg monthly for 1 year. All patients were seropositive by ELISA and Western blot at birth. At the time of the study, 15 symptomatic (P2) and 57 asymptomatic (P1) patients with evidence of viral infection (positive HIV culture or P24 antigen) received the immunoglobulin. Sixty-three indeterminate (PO) patients with no evidence of infection served as the control. Mean age for infants in group P2 was 32 months, 26 months for group P1, and 11 months for group PO. Significant reduction in the frequency of bacterial infections (ie, otitis media, upper respiratory tract infections, urinary tract infections, and acute gastroenteritis) was seen in the symptomatic group compared with both the asymptomatic and the control groups. Growth as measured by weight and height > 50th percentile was also markedly better in the symptomatic group than either asymptomatic or control patients. There was no significant difference in head circumference in all three groups. These results indicate that monthly intravenous immunoglobulin infusion (IVIG) appears to be beneficial to both symptomatic and asymptomatic HIV patients in reducing the frequency of bacterial infection and also enhancement of the immune response. However, symptomatic patients responded much better than the asymptomatic patients.

CD4 Lymphocyte Count↗

Features of symptomatic gastroesophageal reflux disease in elderly patients.

OBJECTIVES: Gastroesophageal reflux disease (GERD) is considered common in the elderly and may present with various symptoms, such as heartburn, regurgitation, dysphagia, or chest pain. In this study, we evaluated the patterns of symptomatic GERD and the spectrum of disease activity in the elderly. METHODS: We prospectively studied 476 predominantly male veterans who were referred for upper endoscopy because of symptoms or signs suggestive of upper gastrointestinal disease. All patients were interviewed immediately before the procedure by a physician who used a standardized symptom questionnaire. Endoscopic findings were categorized and graded according to their extent and severity. The prevalence, nature, and severity of esophageal symptoms and their relationship to endoscopic disease severity were then analyzed. Comparisons were made between two age groups, the young (age less than 65 yr old, mean age 55 yr, age range 30-65 yr), and the elderly (more than 66 yr old, mean age 72 yr, age range 66-90 yr). RESULTS: Heartburn without esophagitis was noted in 28% of young and 24% of elderly patients. Hiatal hernia without esophagitis was noted in 15 % of young and 18% of the elderly. The prevalence of various stages of GERD was similar in the two groups (p > 0.1, chi2 test; odds ratio: 0.983; 95% CI: 0.651-1.48). Quantitative esophageal symptom analysis revealed remarkably similar symptom severity scores for both groups for GERD stages I-IV, as well as for symptomatic controls. However, elderly patients with Barrett's esophagus were significantly less symptomatic than the young (symptom index 2.4 +/- 0.6 vs. 4.88 +/- 1.01, p < 0.02). CONCLUSIONS: Among symptomatic adults undergoing upper endoscopy, the elderly appear to have prevalence rates, patterns, and features of symptomatic GERD that are generally similar to those of their younger counterparts. Nevertheless, the severity of symptoms in the subgroup of elderly with Barrett's esophagus is significantly less than in the young and may contribute to poor or delayed recognition of disease.

Adult↗