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PubMed1999

From African health and influenza pandemics to disease in Russia: the medical history of K. David Patterson.

This paper is a personal commentary on the contributions of noted medical historian K. David Patterson. The eightieth anniversary of the onset of the Great Influenza Pandemic of 1918-19 serves as a reminder of his contributions. His works on slavery and disease in Africa, influenza diffusion and the history of cholera and other diseases periodically appeared in Social Science and Medicine. With a publishing career that lasted from 1971 to 1996, his enduring contributions include revised estimates of mortality in Africa during the influenza pandemic of 1918-1919.

Africa↗
PubMed1990

[The clinico-echocardiographic signs of rheumocarditis in acute rheumatism in adults and their dynamics under the influence of antirheumatic therapy].

Of 45 patients with acute rheumatic fever 23 manifested enlargement of the left ventricle. Of these, 14 patients had it combined with an increase in the stroke volume, the syndrome of load with the left ventricular volume. These alterations disappeared or lessened by the end of the treatment. They did not correlate with lesions of the valvular apparatus and were likely to be consequent to the underlying inflammatory process. In patients with the syndrome of load with the left ventricular volume, myocardial contractility was, as a rule, increased or normal, indicating that myocardial contractility remained at a satisfactory level at the initial disease period. Comparative studies of the therapeutic effect of corticosteroids and nonsteroidal drugs (indomethacin and voltaren) have demonstrated that they exert a similar effect on the clinicofunctional signs of rheumatic carditis.

Acute Disease↗
PubMed1999

[Lipid abnormalities in kidney diseases--significance of radical hypolipemic therapy (LDL-apheresis)].

In several renal diseases such as nephrotic syndrome or terminal renal insufficiency changes in lipids metabolism may lead to increase of cholesterol level or changes in its fractions proportions. There are many clinical and experimental observations demonstrating direct toxic effect of lipids on endothelium leading to impairment of endothelial function what can increase damage of glomeruli. It is associated with passive filtration of lipoprotein to mesangium and active fagocytosis by mesangial cells and infiltrating macrophages, which release cytokines and growth factors increasing mesangial proliferation. There are first publications suggesting possibility of application LDL-apheresis-radical cholesterol removing procedure in renal disease. Periodical cholesterol lowering in the blood reduces proteinuria in patients with resistant for pharmacotherapy nephrotic syndrome, especially with focal glomerulonephritis.

Cholesterol, LDL↗
PubMed1990

Detection of asymptomatic initial herpes simplex virus (HSV) infections in animals immunized with subunit HSV glycoprotein vaccines.

The evaluation of herpes simplex virus (HSV) vaccine efficacy will require methods to detect asymptomatic acquisition of HSV infection and to assess the risk of recurrences in these patients. HSV-infected vaccinees should develop antibodies to HSV polypeptides not included in subunit vaccines. Sera from 57 HSV glycoprotein-vaccinated guinea pigs that had asymptomatic initial infections after genital HSV type 2 challenge were collected after vaccination but before HSV challenge and again 30 days after HSV challenge to determine the antibody response to HSV polypeptides. Antibodies to nonvaccine HSV polypeptides were detected in sera collected after viral challenge from 32 (56%) of these 57 animals. Twenty-six (81%) of the 32 animals with detectable antibody developed recurrent disease; however, recurrences also developed in 11 (44%) of the remaining 25 that did not show detectable antibody to nonvaccine HSV polypeptides. The magnitude of vaginal viral shedding during the initial disease period following challenge was significantly lower in animals that did not develop antibody to nonvaccine polypeptides compared with those that did develop antibody (area under the viral shedding curve, 5.2 +/- 3.2 versus 18.1 +/- 5.8; P less than 0.0001) . These data suggest that detection of antibody to nonvaccine HSV polypeptides will identify the majority (70%) of initially asymptomatic vaccinees that develop recurrent disease but that latency can be established even with markedly reduced levels of viral replication that did not induce a detectable antibody response.

Animals↗
PubMedDate not supplied

[A rare case of hypokalemic thyrotoxic periodic paralysis in a Caucasian patient with Basedow's disease].

Thyrotoxicosis periodic paralysis is a very rare complication of thyrotoxicosis in whites, but is more frequently reported in oriental and latin american populations and associates the clinical picture of hyperthyroidism with bouts of paralysis due to hypokalemia. The hypokalemia is due to a massive shift of potassium from the extra- to the intracellular compartment. In this paper the authors report a case of 34-years old white male with an history of hypokalemic periodic paralysis and hyperthyroidism, studied with potassium, thyroid hormone, TSH and thyroid antibodies sampling and thyroid ultrasonography with color-Doppler. The restoration of a euthyroid state with methimazole and propranolol was effective in preventing further episodes of paralysis. It is suggested that the mechanism for the development of the hypokalemic periodic paralysis is the intracellular blockade of potassium by the surplus of thyroid hormones.

Adult↗
PubMed1976

Evidence for the involvement of IgE-basophil system in acute serum sickness.

The role of the basophils in acute serum sickness of rabbits was examined by monitoring daily the absolute number of basophils before, during and after the disease period. After antigen (bovine serum albumin, BSA) elimination, levels of serum IgE and in vitro basophil degranulation in the presence of BSA were determined. The results showed that the onset of glomerular lesions depends upon the simultaneous occurrence of circulating immune complexes greater than 19 S and of an in vivo basophil depletion--probably equivalent to degranulation--reaching 70% of the pre-disease number. Post-disease antigen-dependent in vitro degranulation of the basophils and levels of serum IgE anti BSA did not prove to be good indexes of basophil sensitization. Our data suggest that basophils are instrumental at early stages of the deposition of immune complexes, most probably through their sensitization by membrane-bound IgE antibodies.

Animals↗
PubMed2000

Lipid screening in women.

Evidence of the benefits of lowering cholesterol in various populations continues to grow, but questions persist about screening and treatment of lipid disorders in women. In this paper, we review the distinct features of the epidemiology of lipids and coronary heart disease in women and data from recent long-term treatment trials specific to women. Although data from primary prevention trials in women remain sparse, recent trials demonstrating benefits of cholesterol reduction across a broad range of cholesterol levels and cardiac risk in men and women bolster the conclusion that benefits may extend to asymptomatic women who are otherwise at high risk for coronary disease. Periodic lipid screening beginning in middle age will identify most women who are at high enough risk to merit drug therapy or more intensive individual lifestyle interventions. More detailed consideration of age, diabetes, blood pressure, specific lipid levels, or the ratio of total cholesterol to high-density lipoprotein cholesterol, and other risk factors can more accurately estimate individual risk of coronary heart disease and identify high-risk women most likely to benefit from lipid reduction. Advice about healthy diet, weight control, and physical activity can benefit all women, but authorities differ on the benefits of routine lipid screening in low-risk younger women.

Adult↗
PubMed1979

Susceptibility of inbred mice to chronic central nervous system infection by Theiler's murine encephalomyelitis virus.

The present study demonstrated that the clinicopathological expression of the late demyelinating disease due to chronic central nervous system infection by Theiler's mouse encephalomyelitis virus was dependent, at least in part, on the strain of mouse used as host. A range of involvement was observed, with late disease being most severe in the SJL strain, intermediate in the CBA and C3H/He strains, and least in C57BL/6 mice. The lack of clinical signs in seven other inbred strains of mice indicates that their response to chronic infection was similar to C57BL/6 mice. SJL, CBA, C3H/He, and C57BL/6 mice all generated similar levels of neutralizing antibody. A correlation between the severity of late disease and central nervous system virus content was not demonstrated, which indirectly suggests an immunopathological rather than a cytolytic mechanism of myelin injury during the late disease period. Finally, in addition to being more extensive, SJL demyelinating lesions contained a disproportionately large number of macrophages compared with those of similar lesions in CBA and C3H/He mice.

Animals↗
PubMed2004

The challenge of emerging and re-emerging infectious diseases.

Infectious diseases have for centuries ranked with wars and famine as major challenges to human progress and survival. They remain among the leading causes of death and disability worldwide. Against a constant background of established infections, epidemics of new and old infectious diseases periodically emerge, greatly magnifying the global burden of infections. Studies of these emerging infections reveal the evolutionary properties of pathogenic microorganisms and the dynamic relationships between microorganisms, their hosts and the environment.

Animals↗
PubMed1991

[Modes of use of central venous catheters in pediatric hematology].

The authors have studied a population of 51 children in which 63 central venous catheters were used for the treatment of leukemias, solid tumors and lymphomas. Two groups were isolated: continuous hospitalization (group A) and intermittent hospitalization with periodical day care (group B). Mean duration of catheterization was 129 days in group A and 176 days in group B (whole population: 149 days), with a total of 9,724 days of catheterization. There was no significant differences between the two groups concerning infection, bleeding, thrombosis or migration. So the authors believe that permanent hospitalization is not mandatory for chemotherapy in children with severe malignant diseases. Periodical day care therapy allows a near normal life for children and a better cooperation from their parents.

Adolescent↗
PubMedDate not supplied

Cytosolic calcium alterations in platelets of patients with early stages of Alzheimer's disease.

Alterations in calcium homeostasis might be implicated in the neuropathology of Alzheimer's disease (AD). To date it is not clear whether changes in cytosolic calcium level ([Ca2+ ]i) are the result or the cause of pathogenic effects. In platelets of patients with early stages of AD, the basal values of [Ca2+]i in the absence of extracellular Ca2+ were significantly lower in comparison with age-matched and young controls. After the addition of 1 mM calcium into the incubation medium the [Ca2+]i markedly increased in platelets of AD patients whereas the increase only to a smaller extent was observed in control age-matched and young subjects. The present study proposes that calcium dysregulation during the whole disease period could not be uniform and according to our results the [Ca2+]i is reduced in the first stages of AD. We suggest that the disturbed calcium homeostasis in AD is an "early defect."

Aged↗
PubMed2006

Multiple non-tumorous arterioportal shunts due to chronic liver disease mimicking hepatocellular carcinoma: outcomes and the associated elevation of alpha-fetoprotein.

PURPOSE: To elucidate the morphologic appearance of small non-tumorous arterioportal (AP) shunts mimicking hepatocellular carcinoma on helical computed tomography (CT), their associated outcomes, and their relationship with alpha-fetoprotein levels in patients with chronic liver disease. MATERIALS AND METHODS: Ten patients with multiple AP shunts on dynamic helical CT were evaluated. A non-tumorous AP shunt was defined as no increase or spontaneous regression in size on follow-up CT scans. The number and shape of shunts more than 5 mm in diameter were studied on a segment-by-segment basis on the initial CT scan, and compared with those on follow-up CT scans. Alpha-fetoprotein levels were measured at the same time as CT scanning was performed. RESULTS: Ten patients with 86 AP shunts (range 0.5-3.8 cm; mean 1.2 cm) underwent arterial, portal and delayed phase imaging of the entire liver. The AP shunts were geographic (44%), round (33%) or wedge-like (23%) in shape. All shunts changed from high- to iso-attenuation on the delayed phase CT. A follow-up CT (mean 73 days) revealed spontaneous disappearance in all but three (97%) of the 86 AP shunts. Furthermore, 16 new shunts appeared in different segments from the primary ones in four patients. The rapid elevation of alpha-fetoprotein levels to 5-10-fold higher than the baseline level was recognized at the same time as the initial appearance of AP shunts in three patients (30%). Further follow-up CT scans detected solitary hepatocellular carcinomas in four patients at a mean 1283 days after the initial CT. The location of the hepatocellular carcinomas was quite different from those of the initially recognized AP shunts. CONCLUSIONS: Non-tumorous AP shunts varied in CT appearance and demonstrated iso-attenuation in the delayed phase, most of which disappeared within 4 months. For these multiple small stains in chronic liver disease, periodic follow-up CT is recommended rather than alternative invasive interventions, even though there was an association with rapid elevation of alpha-fetoprotein levels.

Adult↗
PubMed2003

[Biorhythmical characterization of exacerbations of the degenerative-dystrophic process in patients with the impaired hip joint].

The age-dependent structure of the contingents treated conservatively at the local outpatient clinics (197 women aged 17-82 and 59 men aged 25-85) and patients subjected to operations of total endoprosthesis of the hip joint for coxarthrosis (663 women aged 19-89 and 304 men aged 22-82) was investigated. The structure of the indices under study was found to fluctuate with the average period length 10.7 years (sigma = 2.7 years), 8.2 years (sigma = 3.5 years), 7.3 days (sigma = 3.0 years), 9.5 years (sigma = 2.1 years) respectively. A comparison of the fluctuation curves of the age-dependent structure of the women treated conservatively and operated upon showed the coincidence of the maximums in 35, 43, 60, 65, 69, 74-74 years of age, in men--in 34-35, 41, 75-76. It can be supposed that the revealed age-dependent fluctuations of activity of the inflammatory process and the pain syndrome correspondingly might be considered as an element of the periodic disease in pathogenesis of degenerative-dystrophic lesions of the hip joint.

Adolescent↗
PubMedDate not supplied

[The autumn crocus: two millenniums of actuality].

Colchicum holds a singular place in the History of Medicine. Many names were given through the ages: "ephemera", "finger of Hermes", "pater noster", "tue-chiens". Modern phytonyms clearly refer to the land of Colchis, a mythical place close to Armenia. Several centuries were needed to understand that, despite a frightening reputation, colchic was an elective treatment for the gout. In its long story, appears famous personages as Theophraste, Paulus Aeginata, Gilbertus Anglicus, the baron Storck and Benjamin Franklin. In modern times, colchicum has received besides gout, a wide array of new indications, among others: Behcet disease, collagen diseases and malignancies. A scarcely known chapter of genetics is the findings in 1889, by B. Pernice, an obscure physician from Palermo, of the major mitoic changes observed on gastric and intestinal mucosa of two dogs which had received large doses of colchicum. In spite of their scientific value, the works of Pernice remained largely ignored until 1949. Recent advances in colchiocotheraphy have shown fascinating new fields for research: thus in the familial Mediterranean fever, close to periodic disease, genetic disorder elective for subjects originated from all over Mediterranean and around Black Sea... the mythical country of Colchis. No other medicinal plant than colchic, except poppy, can give such records of perennial use in such a wide range of disorders.

Animals↗
PubMed2005

Lay perceptions of type 2 diabetes in Scotland: bringing health services back in.

The growing prevalence of type 2 diabetes is placing Scottish health services under considerable strain. Consequently, diabetes services are undergoing a major process of reorganisation, including the devolvement of routine diabetes care/diabetic review from secondary to primary healthcare settings. This qualitative study was devised to explore newly diagnosed type 2 diabetes patients' perceptions of their disease and the health services they receive at a time when this restructuring of services is taking place. The sample comprised 40 patients resident in Lothian, Scotland, who had diverse experiences of services, some receiving GP-based care only, others having varying contact with hospital diabetes clinics. In-depth interviews were undertaken with patients, three times at six monthly intervals over 1 year, enabling their experiences to be tracked at critical junctures during the post-diagnostic period. Disease perceptions and health service delivery were found to be mutually informing and effecting. Not only did (different types of) health service delivery influence the ways in which patients thought about and self-managed their disease, over time patients' disease perceptions also informed their expectations of, and preferences for, diabetes services. We thus argue that there is a need for a reconceptualisation within the medical social sciences to take into account the context of healthcare and the economic/policy factors that inform health service delivery when looking at patients' disease perceptions. We also discuss the logistical and ethical challenges of drawing upon patients' perspectives, preferences and views in the design and delivery of future health services.

Adult↗
PubMed1991

[Mechanism of accumulation of prion amyloid in the CNS in experimental amyotrophic leukospongiosis].

The mechanism of accumulation of prion amyloid in guinea pig CNS in experimental slow virus disease--amyotrophic leuco-spongiosis (AL) was studied. The complex histochemical, immuno-cytochemical and ultrastructural studies revealed specific amyloid deposits in a few brain capillaries and in most of pia matter vessels. Taking into account the high AL agent titer in spleen throughout the disease period, conclusion was drawn of entering AL agent in CNS through blood-liquor barrier and blood-brain barrier. It was supposed that primary immune system damaging took place in AL pathogenesis.

Amyloid↗
PubMed2002

Gamma knife radiosurgery for brain metastases: do patients benefit from adjuvant external-beam radiotherapy? An 18-month comparative analysis.

OBJECTIVE: To analyze 18 months of results of gamma knife stereotactic radiosurgery in the treatment of brain metastases and determine factors affecting outcome by examining the effectiveness of additional external-beam radiotherapy (XRT). MATERIALS AND METHODS: Between January 2000 and September 2001, 61 patients with 103 tumors diagnosed as cerebral metastases were treated with gamma knife. Mean patient age was 57 years (range = 36-81). Lung carcinoma (55.7%) was the most common primary cancer, followed by melanoma (14.8%) and breast carcinoma (11.5%). Mean KPS of the patients was 70 (range = 50-90). Twenty-seven patients had solitary metastases while 34 had multiple tumors. Forty-three patients (59 tumors in total) received only radiosurgery, while 18 patients (44 tumors in total) had prior XRT. Tumor volume ranged from 0.5 to 33 cm(3) (mean = 9.74 cm(3)). Mean marginal dose prescription to the tumor was 15 Gy (range = 11-21 Gy). RESULTS: Median follow-up was 11 months. Twenty-one patients (34.4%) were alive at last follow-up and 40 (65.6%) had died. Seventeen deaths (42.5%) were reported to be due to progressive brain disease, while 23 deaths (57.5%) were due to uncontrolled primary. Control of the treated lesions was achieved in 45 patients (73.8%) and 84 tumors (81.6%). Mean overall survival of the patients is 8 months (range = 1-19 months). The actuarial 12-month tumor control rate using the Kaplan-Meier method for this series is 68.2 +/- 0.06%. Results of the log-rank test revealed that younger age (<55 years), small tumor volume (<10 cm(3)), and increasing tumor dose (>15 Gy) correlated with improved brain disease-free survival (p < 0.05). Overall survival, local tumor control rate and the freedom from brain disease period (based on the appearance of new brain tumors after radiosurgery) were analyzed separately for the groups receiving radiosurgery alone and those with prior XRT to detect any additional benefit of XRT. No statistically significant difference was found between the two groups for any of the considered outcomes. CONCLUSION: Gamma knife stereotactic radiosurgery is a safe and effective treatment option for patients with cerebral metastases. It provides survival benefits and improves quality of life by achieving excellent control of the brain disease, irrespective of patients' age or number of brain tumors. The addition of XRT in younger patients with small brain metastases does not improve survival and/or control of the brain disease.

Adult↗
PubMed2003

Inflammatory bowel disease Part 1: ulcerative colitis--pathophysiology and conventional and alternative treatment options.

Ulcerative colitis (UC), a subcategory of inflammatory bowel disease, afflicts 1-2 million people in the United States, and many more worldwide. Although the exact cause of ulcerative colitis remains undetermined, the condition appears to be related to a combination of genetic and environmental factors. While conventional treatments can be effective in maintaining remission and decreasing the length of active disease periods, the treatments are not without side effects, and a significant number of people suffering from UC fail to respond to even the strongest drugs. This article reviews potential unconventional treatments - transdermal nicotine, heparin, melatonin, DHEA, probiotics, fiber, dietary changes, botanicals, essential fatty acids, and other nutrients - that may be considered in conjunction with conventional approaches or as part of a comprehensive alternative treatment protocol. In addition this review addresses risk factors, pathogenesis, nutrient deficiencies, conventional treatment approaches, and extra-intestinal manifestations of the disease.

Butyric Acid↗