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[Simultaneous bilateral pneumothorax complicating Pneumocystis carinii pneumonia in a homeless man with AIDS].

Although pneumothorax is a well-known complication of AIDS related Pneumocystis carinii pneumonia, simultaneous bilateral pneumothorax has not been reported in Japan. A 54-year-old homeless man was admitted with emaciation and dyspnea. Chest X-ray showed diffuse ground glass opacity. Computed tomography of the chest demonstrated ground glass opacity and cyst-like lesions in both upper lobes of the lung. The patient was HIV positive. Grocott's stain of a bronchial lavage specimen demonstrated Pneumocystis carinii microorganisms. Intravenous trimethoprim-sulfamethoxazol and steroid administration was started. Seven days later, the patient developed tension pneumothorax of the right lung. Immediately after the thoracostomy, contralateral pneumothorax developed. Another chest tube was inserted. Subsequently, the patient died from bilateral pneumothorax. The endemicity of HIV infections among the homeless population is already a significant problem in Western countries. We should be aware that HIV infection may become a problem among the Japanese homeless as well.

AIDS-Related Opportunistic Infections↗

[Clinical effectiveness of the therapeutic nutrition of sick children using enteral feeding preparations and low-lactose mixtures].

The paper concerns the results of clinical trials of new specialized foods--protein, defatted and fat enpits as well as low lactose milk mixtures, which were used in dietotherapy of sick children with different disease entities (hypothrophy, bronchopulmonary abnormalities, emaciation pre- and postoperatively, mucoviscidosis, Laurence-Moon-Bardte-Biedle's syndrome, Marfan's syndrome, galactosemia, lactase deficiency). The diets including new therapeutic foods were shown to exert high therapeutic effects, that gave grounds for the methodological recommendations for using them in pediatrics to be given.

Body Weight↗

NTP technical report on toxicity studies of t-butyl alcohol (CAS No. 75-65-0). Administered by inhalation to F344/N rats and B6C3F1 mice.

t-Butyl alcohol is widely used in the manufacture of perfumes and a variety of cosmetics. It is also used as a raw material in the production of isobutylene, which may be used to produce methyl tertiary butyl ether, a common gasoline additive, or to produce butyl elastomers used in the production of automobile tires. The National Cancer Institute nominated t-butyl alcohol to the NTP for study as a result of a review of chemicals found in drinking water. In addition to the high annual production and the potential for occupational exposure, there is also a potential for human exposure to t-butyl alcohol by the inhalation route from its use as an additive in unleaded gasoline. Therefore, toxicity studies of t-butyl alcohol were conducted in male and female F344/N rats and B6C3F1 mice by whole-body inhalation. Animals were evaluated for hematology, clinical chemistry, urinalysis, reproductive toxicity, and histopathology. The genetic toxicity of t-butyl alcohol was assessed by testing the ability of the chemical to induce mutations in various strains of Salmonella typhimurium and L5178Y mouse lymphoma cells or sister chromatid exchanges and chromosomal aberrations in cultured Chinese hamster ovary cells, and by measuring the frequency of micronucleated erythrocytes in rat bone marrow and mouse peripheral blood. In the 18-day inhalation studies, groups of five male and five female rats and mice were exposed to t-butyl alcohol by inhalation at concentrations of 450, 900, 1,750, 3,500, and 7, 000 ppm for 6 hours per day, 5 days per week, for 12 exposure days. All rats and mice exposed to 7,000 ppm were killed moribund following a single 6-hour exposure. One 3,500 ppm male mouse died on day 3. Final mean body weights of 3,500 ppm male and female rats were significantly lower than those of the controls. Final mean body weights and body weight gains of all other exposed groups were similar to those of the controls. In animals exposed to 3.500 ppm, the thymus weights of male and female rats and female mice were less than those of the controls. The liver weights of male and female mice exposed to 3,500 ppm were greater than those of the controls. No grss or microscopic lesion were present in rats or mice. In the 13-week inhalation studies, groups of 10 male and 10 female rats and mice were exposed to t-butyl alcohol at concentrations of 0, 135, 270, 540, 1,080, and 2,100 ppm for 6 hours per day, 5 days per week, for 13 weeks. One 2,100 ppm and five 1,080 ppm male mice died before the end of the studies. The final mean body weight of 2,100 ppm female mice and the mean body weight gains of 1,080 and 2,100 ppm female mice were significantly lower than those of the controls. Clinical findings of toxicity in the 1,080 ppm male mice died during the studies included rough coats and emaciated appearance, hypoactivity, and prostration. Minimal decreases in hematocrit values, hemoglobin concentrations, and erythrocyte counts occurred in the 1,080 and 2,100 ppm male rats at week 13. Hemoglobin concentrations and/or hematocrit values were also minimally decreased in male rats in the lower exposure groups. At week 13, a minimal decrease in urine pH occurred in the 1,080 ppm female and 2,100 ppm male and female rats. Neutrophilia occurred in the 2,100 ppm male mice. Organ weight differences in exposed rats included increased absolute and relative kidney weights of 1,080 ppm males and 2,100 ppm males and females and increased relative liver weights of 1,080 and 2,100 ppm females. There were no treatment-related gross findings in male or female rats or mice; no microscopic lesion occurred in female rats or male or female mice that survived to the end of the study. In male rats, there was an exposure concentration-related increase in the severity of chronic nephropathy. Splenic lymphoid depletion was present in male mice that died during the studies; this lesion was presumed to be secondary to stress. t-butyl alcohol produced no adverse effects on reproductive parameters in male or female rats or mice. The results of all tests of t-butyl alcohol for induction of genetic damage in vitro and in vivo were negative. In vitro, t-butyl alcohol was negative in Salmonella typhimurium and mouse lymphoma cell mutation test, and it did not induce sister chromatid exchanges or chromosomal aberrations in cultured Chinese hamster ovary cells. These in vitro studies were conducted with and without metabolic activation (S9). In vivo, no increase in the frequency of micronucleated erythrocytes was observed in peripheral blood samples from mice administered t-butyl alcohol in drinking water for 13 weeks. Also, induction or micronucleated erythrocytes was noted in bone marrow cells of rats administered t-butyl alcohol by intraperitoneal injection. In summary, inhalation exposure of rats and mice to t-butyl alcohol resulted in deaths following a single 7,000 ppm exposure and clinical findings of alcohol toxicity (hyper- and hypoactivity, ataxia) at concentrations of 900 ppm and greater in rats and 1,750 ppm and greater in mice. In 13-week studies at concentrations up to 2,100 ppm, only one death (that of a 2,100 ppm mouse) was attributed to chemical exposure. The most notable evidence of toxicity at the end of 13 weeks was limited to males and consisted of increased kidney weights, which correlated microscopically to increased severity of chronic nephropathy. Reproductive parameters in male and female rats and mice were unaffected after 13 weeks of exposure, and the results of all tests for genetic toxicity were negative.

Administration, Inhalation↗

Hypervitaminosis A in the dog.

Toxic effects of excessive vitamin A and of excessive vitamin ADE were studied in 9 mixed Labrador Retriever pups. Clinical signs were loss of body weight, dullness, emaciation, roughened coat, evident pain in limb joints, and retarded growth. Radiologic changes were decreases in overall length and thickness of long bones, development of osteophytes, periosteal reaction, and premature closure of epiphyses. Pathologic changes were degenerative epiphyseal plate, hemorrhage and exostotic proliferation of periosteum, fatty liver, and microcalculi in kidney. Toxic effects of excessive vitamin A did not appear to be so great when it was administered as vitamin ADE.

Animals↗

Atypical piscine mycobacteriosis in Japanese medaka (Oryzias latipes).

Japanese medaka, (Oryzias latipes), small, freshwater, tropical cyprinodonts, are principally used for toxicologic and carcinogenicity assays, but are finding more applications in developmental genetic and biological research. An increase in mortality began in brood stock of adult medaka that had been shipped and housed separately by sex. Initially, mortality averaged one fish daily and began in females two weeks after they were received. Cohabitation began eight weeks after arrival. After four to six weeks of cohabitation in different spawning aquaria, mortality was observed in males. Clinical signs of disease included loss of scale luster and color, with subsequent blanching of dorsal flank musculature, small raised nodules on various external surfaces, emaciation, fraying of fin tips, and equilibrium disturbances. Histologic examination of affected adults revealed multi-organ granulomatous inflammation with intracellular acid-fast bacilli. Specimens from 46 juvenile medaka that were spawned from affected adults, were submitted for culture and histologic evaluation. Of 18 fish, two had lesions similar to those of adults. The organism isolated from the remaining fish was identified as Mycobacterium fortuitum. Due to atypical rapid progression of disease, spread of M. fortuitum to progeny, and poor prognosis, the entire colony was euthanized.

Animals↗

October 2001: 40-year-old Xhosa male with back pain and leg weakness.

A 40-year-old Xhosa male presented with progressive upper lumbar back pain and weakness At examination he was emaciated and had enlarged lymph nodes in the groin and axilla. Both lower limbs were severely atrophic and weak. Sensation to touch and pain was decreased below L3 bilaterally. MR of the spine showed a discrete, contrast-enhancing epidural mass. A T10-T12 laminectomy revealed an soft, vascular extradural tumor dorsal to the cord. The mass was loosely applied to the dura and easy to remove. The operative specimen consisted of a sausage-shaped (3.5 x 2.0 x 1.2 cm), thinly-encapsulated mass of reddish-brown tissue. The cut surface had a mottled, vaguely nodular, yellowish-brown appearance. Microscopic examination revealed sheets of hematopoeitic elements, including myeloid, red cell and megakaryocytic lines, the latter showing Factor 8-related positivity. The final diagnosis was extramedullary hematopoiesis (EMH). A bone marrow biopsy performed as a result of the diagnosis showed a myeloproliferative disease and polycythemia vera. EMH in the spinal epidural space is a rare but treatable cause of progressive paraparesis in patients with a variety of hematological disorders. Since 1956 there have been more than 50 reported cases, most of which occurred in association with thalassaemia. In spinal cord compression secondary to EMH, the lesions are commonly localized to the mid-lower thoracic region.

Adult↗

[Morbidity in the ghettos during the Holocaust].

The environmental conditions and daily life in the ghettos of Europe during the holocaust are reviewed, and their effect on morbidity in different ghettos is scrutinized in an attempt to construct a typical morbidity profile. The outstanding characteristics were: crowding, shortage of basic necessities (such as food, clothing and medications), harsh environmental and sanitary conditions, inclement weather, poor personal hygiene, chronic undernutrition and malnutrition, physical and mental exhaustion. Morbidity was mainly due to infectious diseases, both endemic and epidemic outbreaks with high mortality, and high infestation rates of lice and other parasites. The dominant feature was "hunger disease" with its protean clinical expressions, endocine pathology, growth and development retardation in children, and amenorrhea and infertility among women of child-bearing age. Polyuria, nocturia and increased frequency of bowel movement were common. The typical presentation of a ghetto dweller was of extreme emaciation (a loss of up to 50% body weight); muscle weakness and skeletal abnormalities; pale, dry skin with excoriations; pedal edema; anxiety and nervousness; often goiter in children. Most of the inhabitants had some, or all, of those signs and symptoms (there were times when more than half the population was sick). This syndrome complex was termed "Ghetto Sickness" or "Ghetto Fatigue" (ghetto schwachkeit).

Germany↗

New-Fill to treat facial wasting.

Looking in the mirror can be a humbling experience. For HIV positive people with facial wasting, or lipoatropy, the experience can be traumatic. Facial lipoatropy refers to subcutaneous fat loss in the cheeks and temples resulting in a bony, emaciated appearance. The condition may mild to severe. As with other symptoms of lipodystrophy, or body fat abnormality syndrome (such as fat loss in the limbs and buttocks, and fat accumulation in the abdomen), the only thing known for certain about facial wasting is that it exists; precise causes have not been identified and successful strategies to prevent the condition remain elusive. A recently developed cosmetic treatment for facial wasting, polylactic acid (PLA) or New-Fill, appears to be well tolerated in European clinical trials and anecdotal reports. Although the treatment has been approved in Europe and Mexico, the future of PLA access in the U.S. remains uncertain.

Adaptation, Psychological↗

A natural case of Schistosoma mansoni in the chimpanzee (Pan troglodytes versus).

A spontaneous infection with Schistosoma mansoni was found in a chimpanzee (Pan troglodytes versus) recently imported from Sierra Leone, Africa. Clinical signs consisted of anemia, liver enlargement, bronchial rales, and emaciation. The primary gross pathologic lesions included a fibrotic firm nodular liver and pulmonary edema and consolidation. Histopathologic examination revealed changes similar to the experimental syndrome of Manson's schistosomiasis in the chimpanzee. The diagnosis was confirmed by the presence of the eggs and larvae of Schistosoma mansoni.

Anemia↗

[Signs of miliary tuberculosis: which diagnostic tests and when to treat?].

Three patients, men aged 21, 57 and 53 years, presented with variable non-specific symptoms such as general malaise, weight loss, elevated temperature, abdominal pain, cough, pulmonary crepitations and elevated liver enzymes. Diffuse fine nodular infiltration was seen on chest radiography in the last two cases. The first patient refused to be tentatively treated with tuberculostatics and died. Mycobacterium tuberculosis complex grew on Löwenstein medium a week later. The two other patients received tuberculostatic treatment. The second patient recovered, while the third patient suffered a cerebrovascular accident on top of emaciation and respiratory insufficiency and died. In the Netherlands, currently more than one hundred patients with tuberculosis disease die each year. The disease is mostly seen in people from the high-risk groups for tuberculosis such as asylum seekers and immigrants. Even after extensive diagnostic procedures it can be difficult to obtain rapid bacteriological confirmation. When miliary tuberculosis is suspected it is important to carry out the complete range of tests (Ziehl Neelsen microscopy, PCR, Löwenstein cultivation) and to start therapy immediately and not to await the results of the diagnostic tests. However, in many cases this may still be too late, with an estimated mortality of 20%.

Adult↗

Two autopsy cases of diffuse gastrointestinal polyposis with ectodermal changes. Cronkhite-Canada syndrome.

Two autopsy cases of Cronkhite-Canada syndrome were reported. The caused of hypoproteinemia, electrolyte imbalance and ectodermal changes were discussed with reference to previously reported cases. The mechanism of protein loss was probably due to outflow into the intestinal lumen of the mucous substance in the cystically dilated glands, directly and/or indirectly followed by loss of mucosal surface. Electrolyte imbalance probably developed from gastrointestinal loss as well as poor substitution. The ectodermal changes were probably not a subsequent part of the emaciation or hypoproteinemis, but an inherent part of this disease. Therapy, whether substitution or surgical procedure, should be selected in order to control the general condition of the patient.

Adult↗

[A study on far-advanced cavitary pulmonary tuberculosis cases].

In cases with far-advanced cavitary pulmonary tuberculosis, the most serious lesions according to the chest X-ray classification by the Japanese Society of Tuberculosis (b I 3), their prognosis is believed to be poor due to their emaciated general conditions, and a retrospective clinical study was made on these cases admitted to our hospital. The subjects consisted of 95 cases, and among them 87 were male and 8 were female, and their mean age was 49.5 +/- 13.0 years. Eighty four cases were detected by symptomatic visits to clinics, 10 cases during their treatment for other diseases, and 1 case was discovered accidentally. Sputum examination for acid fast bacilli was all smear positive. As to their social background, the majority were occupied by socially vulnerable groups; 31 cases (32.6%) were jobless on admission, 24 cases (25.3%) were day laborers, and 25 cases (26.3%) were receiving poor relief. Regarding their general condition on admission, 40 cases were very serious and they could not stand by themselves, and their nutritional conditions were poor, and 19 cases (20%) died during hospitalization. All of them were male, and they were found by symptomatic visit to clinics. The period from hospital admission to death was short, the average was 35.0 +/- 39.8 days, and the median was 11.0 days. Among 84 patients detected by symptomatic visit, the patient's delay was 5.5 +/- 5.0 months, while the doctor's delay was 0.3 +/- 0.9 months. Major cause of late detection at advanced stage of these cases was patient's delay which caused poor prognosis of these cases, and various measures to shorten the delay in case-detection must be taken.

Adolescent↗

[GASTRIC CANCER IN PATIENTS YOUNGER THAN FORTY YEARS OLD.HOSPITAL LOAYZA EXPERIENCE BETWEEN 1991 - 1998]

A retrospective study was performed on patients diagnosed of gastric cancer, younger than 40 years old, in the Hospital Arzobispo Loayza, from January 1991 to December 1998.We found 81 patients younger than 40 years old, with confirmed diagnosis of gastric adenocarcinoma; we reviewed the records of 59 patients.There were 44 (74.6%) women and 15 (25.4%) men. The mean age was 31.644 +- 5.437 years and the mean duration of symptoms was 13.189 months.The most common symptoms were: epigastric pain (89.8%), weight loss (86.4%), dyspepsia (64.4%),vomiting (64.4%) and nausea (62.7%). The most frequent physical findings were pallor (62.7%), epigastric tenderness (40.7%) and emaciation (37.3%). 57.8% of patients had hemoglobine levels of less than 11 gr/dl.The most frequent location of the neoplasm was the antrum (31.1%) followed by the body (27.3%).On endoscopy, we observed that the most frequent lesion was advanced gastric cancer, Borrmann III (48%), followed by Borrmann IV (27.3%). The predominant histologic type was undifferentiated adenocarcinoma.

Journal Article↗

Paucibacillary paratuberculosis in a goat.

A 5-year-old Saanen doe was presented with emaciation, good appetite, normal feces, and a dry flaky hair coat. Johne's disease was tentatively diagnosed. Gross postmortem findings were a thickened, corrugated ileum and enlarged edematous mesenteric lymph nodes. Histologically, there was extensive lymphocytic infiltration of the ileal lamina propria. Mycobacterium paratuberculosis could not be identified or cultured.

Animals↗

[Reactional status of leprosy].

Reactional leprosy is studied according to its clinical forms A) Lepromatous a) Acute lepromatization: encroaching and invasive nature; the patient becomes more and more lepromatous ; bad prognosis. b) Erythema nodosum: "contusiform dermatitis"; variable prognosis not so bad as it is in the preceding case; allergic nature and its evolution is usually detained and therapeutics efficient. c) Erythema multiform. d) Lucio's phenomenon: vascular lesions and consequently necrosis as a complication of the "erythema necrotisans" (beautiful leprosy). B) Tuberculoid Reactional tuberculoid is the only one in this benign type, the Mitsuda's test must always be positive and prognosis consequently good. C) Dimorphous or "Borderline" whose Mitsuda's test is mostly negative, sometimes positive, but not stable. The lesions may stimulate the tuberculoid leprids but they invade mucous membranes, are impregnated by pigmentation, may present the Unna's band, and other characteristics of the Lepromatous type. Are associated (fever, asthenia and emaciation). Prognosis not very good, because of the possibility of lepromatization, according to its tendency. Evolution slower and frequent relapses. Besides there are nodular lesions. Pathogeny 1) Perifocal allergic reaction (Jadassohn). Similar to epituberculosis and Herxheimer reaction. 2) Septicemia. Sensitized tissues inside or outside the lesions, are invaded by the bacilli and so the allergic reaction takes place. Even without culture resources, Mycobacterium leprae has been found in the blood by direct examination. 3) Autoimmunization (Waldenstrom, Matthews and Trantman, 1965). Based upon the similarity between both humoral syndromes, in leprosy reactions and collagenous, diseases, as to: hypergammaglobulins, hypercryoproteins, antigammaglobulins, serological reactions (Wassermann, Kahn, Kline, VDRL) positives, Antistreptolysin O, protein C reactive, antinuclear factors, latex and Wadler-Rose test positives (rheumatoid tests) lowering of complement. If leprosy reaction is like this, it should be the less agressive of the autoimmune diseases. a) Its eruptions are cyclic not of long standing duration, as a general rule. b) Its prognosis has been recognized as good, except lately, because of the use of corticoid therapy which has been fatal, in many cases. After some years the leprosy reaction cures spontaneously. Treatment (see article)

Erythema Multiforme↗

[Forensic autopsy cases of battered children in Japan (1990-1999)].

The investigation committee of Japanese Society of Legal Medicine has investigated 459 forensic autopsy cases of battered children from 1990-1999. The age range was 0-4 years of 381 cases (83%). Of them, the age less than 1 year was high as 161 cases (35.1%). The cause of death including head injury was 161 cases (35.1%), suffocation caused by nasal blockages 37 cases (8.1%), strangulation 32 cases (7.0%), and drowning 30 cases (6.5%) was revealed. In case of assailant, own mother was 226 cases (49.2%), own father was 73 cases (15.9%) and stepfather 46 cases (10.0%) were reported. The intention of cruelty was that the body was positively assaulted (84.3%) and duration was less than 2 months in 136 cases (67%). The nature of cruelty was that beating by other hands (16.8%) in 77 cases and pushed away and threw (1.7%) in 8 cases and those complex (7.8%) in 36 cases. The motive of cruelty when he assailant was own mother (209 cases) was as fellow: 1. Mentally abnormal (15.3%), 2. Irresponsibility (14.4%), 3. Victim cries (5.7%). When the assailant was own father (63%), the motive of cruelty was as 1. Victim cries (12.7%), 2. Lack of love (7.9%), 3. Reassisted attitude (6.3%). Reported death in high temperature was in 29 cases (6.3%) and strangulation was in 27 cases (5.9%). The homicide was 13% and neither care nor protection (neglect) was 2.7%. The physical conditions of battered children were emaciated and stunted growth in 128 cases (31.2%). The past history of medical consultation to the medical hospital was 32 cases (17.8%). Among the injuries, external findings consist of abrasions and bruises were 147 cases (32%) and internal findings were 70 cases (16.7%) mainly numerous gastro-intestinal tract injuries than liver and lungs. In addition, lung edema (16.8%) in 68 cases, thymus atrophy (12.6%) in 51 cases and amalgamation (4.5%) in 18 cases were reported. The injury around the anus and genitalia were 13 cases (3.2%). The bone fracture was not observed in 368 cases (80.2%) out of 459. Among the intracranial injuries, subdural haemastoma or amalgamation were 31.6% (145 cases) out of 459.

Adult↗

[Clinical features of Crohn's disease: its diagnosis and treatment].

OBJECTIVE: To enhance our understanding of Crohn's disease and improve its early diagnostic accuracy and therapeutic efficacy. METHODS: Thirty-one patients with active Crohn's disease were studied. All their diagnostic and therapeutic results were analyzed. RESULTS: Most patients were young adults, with a 1.14:1 female predominance in prevalence. The disease affects any segment or a combination of segments of the alimentary tract from the mouth to the anus. However, the colon and the small bowel were the major sites involved. Recurrent episodes of abdominal pain and watery diarrhea were the most common symptoms. In addition, low grade fever, emaciation, anemia, and symptoms with skin, joints or perianal complications could be discovered if attention was paid. An endoscopy combined with histologic examination in biopsy specimens provided characteristic features with a diagnostic accuracy of 62.9%. Granulomas were identifiable in 30.8% of all biopsy specimens. Transabdominal bowel sonography (TABS) accurately detected intestinal complications. Factors causing misdiagnosis were: insufficient attention of the disease, diverse clinical presentations, or over emphasis of the diagnostic value of granulomas. Oral prednisone therapy for mild to moderate disease was more rapid to receive clinical remission when compared to oral aminosalicylates (SASP or 5-ASA). Nutrition support therapy was given in 20 cases with active disease and received beneficial effects on host nutritional status. Immunosuppressives were used on an individual basis, and showed variable effects with limited experience. Sixteen patients had operations due to intestinal obstruction or failure to respond to drug therapies. Rapid improvement after operations was achieved. CONCLUSIONS: Crohn's diseases not uncommon in China. Abdominal pain and watery diarrhea are two hallmark symptoms. Endoscopy (with biopsy), and TABS were both valuable procedures for diagnosis. Prednisone and SASP/5-ASA were effective as inductive therapies. Surgery, as an alternative and effective treatment, provided another choice in well selected patients.

Adolescent↗

Chronic wasting disease in a Rocky Mountain elk.

A 24-month-old Rocky Mountain elk was presented because of suspected chronic wasting disease (CWD). The animal was emaciated, had retained its winter hair, and had abnormal behavior patterns suggestive of CWD, including bruxism, ptyalism, and diminished flight zone size. Immunohistochemical analysis of the brain confirmed the diagnosis of CWD.

Animals↗