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In spite of widely dispersed modern knowledge of burn treatment, neglect or inept care of severely burned patients continues as a cause of a considerable medical problem. Since the neglected patient is usually emaciated, pain-ridden and low in morale, prompt attention to rehabilitation through blood transfusions, nourishment, relief of pain and cleansing of the wound is mandatory. Skin grafting as soon as possible is the aim.
Paracoccidioidomycosis is a systemic infection caused by a dimorphic fungus (Paracoccidioides brasiliensis). The most common lesions frequently occur in the bucopharinx mucosa. Other lesions occur in the adrenal glands, liver, bone, gastrointestinal tract, lungs and nervous system. We report here a case of neuroparacoccidioidomycosis. The patient was a 49 year-old male, who consulted due to neurological symptoms (cephalalgia, speech difficulty and one tonic clonic seizure with urinary incontinence) of eight months duration. Upon physical examination it was observed an emaciated male with nail clubbing, a skin ulcer with raised edges and a crusted bottom of 4 x 2 cm in diameter located in the right supraclavicular region and an ulcerated lesion in the left tonsil with edema. The rest of the physical examination reveled a discrete left side hemiparesis and pulmonary rales in the left hemitorax. The fungus was identified through direct examination of cerebrospinal fluid (CSF). The histopathology of suprarenal, lungs, brain and skin showed multiple paracoccidioidal granulomas. To the best of our knowledge, this is the third case reported in the literature. We review the literature on the pathogenesis and prevalence of neuroparacoccidioidomycosis.
A 35-year-old emaciated woman presented with bleeding per rectum with mucoid stool due to a rectal growth which clinically mimicked carcinoma rectum. Anterior resection and biopsy of the resected specimen proved the case to be one of rectal tuberculosis.
Semax and mexidol significantly increase the survival of white mongrel male mice upon bilateral ligation of common carotid arteries. Semax virtually completely prevented retrograde amnesia development in ligated mice under conditions of a complex extremal action (emaciating swim in cold water with simultaneous wheel rotation) and increased the lifetime of these animals in altitude test chamber.
We report the case of a two years old, normally eating child, affected by organic macies and severe dystrophy. After the negative response of blood and laboratory examinations let us exclude a malabsorption syndrome, only the performance of neuro-radiologic exams showed evidence of a subthalamic tumor as the cause of a "Diencephalic syndrome". Diencephalic syndrome or Russell's syndrome is a diencephalic tumor induced disease, which sets in the first time of life. The disease clinical markers are a severe emaciation with appetite preservation and absence or very scarce evidence of any telltale neurological sign. The tumoral histo-pathology most frequently shows a low grade of malignancy astrocytoma, whose eradication is very often difficult because of particular anatomic site. Treatment of choice includes an excisional biopsy with chemotherapy and radiotherapy. We report a clinical case of long-term survival and review of the literature.
Mycoplasma synoviae (MS) was isolated from the sinus of an adult female "wild-type" turkey found feeding with backyard chickens at a private residence in Randolph County, N.C. Clinical signs included sinusitis, dyspnea, emaciation, diarrhea, and nasal discharge. The bird was seropositive for MS and M. gallisepticum (MG) on the rapid plate agglutination test and had titers of 1:160 for MS and 1:20 for MG on the hemagglutination-inhibition test. Isolations of MS and M. gallopavonis were confirmed by the fluorescent antibody test. This case represents the first and only report of MS in a free-ranging "wild-type" turkey in the eastern United States. Behavioral and other evidence suggests that the bird was a released pen-raised turkey.
Type II ostertagiosis was found at necropsy in 9 American bison (Bison bison) from 3 farms in New York. Clinical signs included severe diarrhea, emaciation, unthrifty coats, anemia, and weakness. In severely affected animals, the macroscopic abomasal changes consisted of irregular thickening and edema of the mucosa, resulting in a pebbly or morocco-leather appearance. Microscopically, many gastric pits and glands were dilated, lined by hyperplastic epithelium, and contained nematode sections or debris. Parasites recovered included Ostertagia ostertagi, Trichostrongylus axei, Trichostrongylus lerouxi, Cooperia oncophora, Haemonchus contortus, Nematodirus helvetianus, Trichuris discolor, Setaria labiato-papillosa, Dictyocaulus viviparus, Hypoderma lineatum, and Sarcocystis sp. Nodules in the small and large intestine were attributed to Oesophagostomum sp. Trichostrongylus lerouxi, Trichuris discolor, and Nematodirus helvetianus are reported from bison for the first time.
Infection disease due to Listeria monocytogenes, which is a ubiquitous positive Gram bacillus to the essentially alimentary transmission, listeriosis happens on patients presenting an immunodeficiency. The authors report the two first cases of listeriosis diagnosed at Hopital Principal de Dakar. The first case was observed on a 73 years old man, hospitalised for a feverish coma scored at 9 using Glasgow scale, with neither meningitis syndrome, nor sign of neurological localisation. The analysis of the RLC reveals a hypercytosis at 126 GB/mm3, with prevailing neutrophile polynuclears, a hyperproteinorachia at 3.2 g/l. The culture of the RLC was sterile but the blood culture showed the presence of L. monocytogenes. The other paraclinical tests has revealed a glycaemia at 2.45 g/l, an imporant hepatic cytolisis with ASAT at 13 N and ALAT at 20 N. The patient was also presenting a cerebromeningitis and hepatic listeriosis on a diabetic field. The second case was observed on a 58 years old patient admitted for headaches, fever and an important degradation of the general state with an emaciation of 17 kg in 5 months. The physical screening revealed a bad general state, a fever at 38 degrees 2 and was without other particularity. The analysis of the RLC showed a hyperproteinorachia at 1.35 g/l with neither hypercytosis nor germ at the culture. Haemoculture isolated Listeria monocytogenes. HIV serology was positive. CD4 were counted to 61/mm3. and the viral charge was at 110.000 copies / mm3. The patient was presenting a Listeria monocytogenes at meningo-encephalitis on HIV-1 field. stade B of the CDC classification. This ubiquitous anthropozoonosis should be searched through early haemocultures before antibiotherapy. in case of long lasting fever, endocarditis, meningo-encephalitis, localised infections on children. pregnant women, diabetic persons, and people infected with HIV and some others presenting immunity troubles.
Adequate energy intake including carbohydrates is essential to maintain bone mass. Emaciation along with deficiency in nutrients, such as calcium, vitamin D, and protein is a significant risk factor for bone loss, and should be avoided. However, there is no clinical evidence that shows the direct effects of carbohydrate on bone mass. On the other hand, excessive intake of carbohydrates results in obesity, which causes other metabolic diseases such as diabetes mellitus (DM). Therefore, dietary regimen must be balanced in general, and complications and conditions of individual patients should be taken well into account. In addition, energy intake is a basis for adequate exercise in order to maintain physical activity and ideal body weight, which will further decrease the risk of bone fracture. Some indigestible carbohydrates, such as inulin and oligofructose, are shown to increase the availability of minerals from foods, and thus can be beneficial to bone mass.
In a retrospective survey, the epidemiological characteristics of nursing sickness in Standard Black and Pastel mink (Mustela vison) were examined in a Danish fur research farm. Based on the clinical diagnosis of the disease, the overall morbidity in a total of 1774 lactating females amounted to 14.4% and the case fatality rate to 7.8%. Apparently healthy females weaned an average of 5.0 kits per litter, while dams suffering from nursing sickness raised and weaned an average of 5.4 kits per litter (p less than 0.01). Based on logistic regression analysis, the increasing age of the lactating dam, followed by littersize and female weight loss, appeared to be major determinants for the development of nursing sickness. The impact of additional covariates such as litter weight gain and female color type were remarkably low. At weaning (day 43) the mean individual live weight of the kits of either sex did not differ between healthy and sick dams. In Standard Black, the total biomass of the offspring raised by sick dams was significantly larger than that of the healthy controls (p less than 0.01). During the final two weeks of lactation, apparently healthy dams lost on average 14% of their body mass, whereas those affected by nursing sickness had a mean weight loss of about 31% (p less than 0.001). Postmortem examination of 25 dams with severe nursing sickness verified the clinical findings of progressive dehydration and emaciation. The gastrointestinal tract was empty and gastric ulcers and melaena were frequently present. Other common findings included small livers,enlarged adrenals and pitted kidneys.(ABSTRACT TRUNCATED AT 250 WORDS)
Fifty consecutive children with cerebellar medulloblastoma were operated on May, 1971 to December, 1988. At 5 and 10-years, actuarial survival rates were respectively 46% & 42%. To determine prognostic factors, various clinical and histological features were analysed: multivariate analysis showed that increased vascularity, coagulative necrosis, and postoperative clinical status have a significant influence survival. When necrosis and/or increased vascularity were present (H+), the 5-year survival rate was 17%, whereas it was 70% when absent (H-) (p less than 0.0001). Postoperative clinical status was described as poor when neurological symptoms such as vigilance or vegetative disorders, akinesia, hypotonia, apragmatism, mutism and emaciation were associated; the 5-year survival rate was 10% in the presence of such deficits (C+) and 55% in their absence (C-) (p = 0.0002). From these results, 2 distinct groups were identified: Group 1: 23 patients without pejorative factors (H- and C-); 5 and 10-year survival rates were 80%. Group 2: 27 patients with one or two pejorative factors (H+ and/or C+); 5 and 10-year survival rates were respectively 18% and 12% (p. less than 0.0001). From our experience, it appears that histology and postoperative clinical status can be early predictors of patient outcome, since neurosurgical and radiation therapy techniques have been largely optimized. These factors could be the basis for developing adapted treatment protocols.
We report herein the case of a 28-year-old man presenting with hyperglycemic chorea-ballism (HCB) in addition to mitochondrial encephalopathy, lactic acidosis, and stroke-like episodes (MELAS). He was admitted to a local hospital due to weight loss, general fatigue and thirst. The patient had diabetes mellitus, with a blood glucose level of 738 mg/dl and HbA1c of 19.8%. Although insulin therapy improved hyperglycemia, he noticed involuntary movements in the right upper and lower limbs, which subsequently extended to the left side. The patient was thus transferred to our hospital. He displayed short stature (154 cm) and emaciation, and a maternal family history of diabetes mellitus was elicited. He had no history of stroke-like episode, headache, vomiting and seizure. Neurological examination revealed low intelligence (IQ 57), mild sensorineural deafness, and chorea-ballism in the extremities and head without ptosis or eye movement disturbance. Brain computed tomography (CT) demonstrated areas of high density, while T1-weighted magnetic resonance imaging (MRI) revealed extreme hyperintensity and T2-weighted MRI showed hyperintensity in bilateral caudate nuclei, putamina and globi pallidus. HCB was diagnosed. In, CSF, lactate level was increased to 43.9 mg/dl (n, 4-16), pyruvate level was 1.65 mg/dl (n, 0.3-0.9) and total protein concentration was 59 mg/dl. Histological examination of a biopsy sample from the biceps brachii muscle demonstrated ragged-red fibers. An A3243G point mutation in the tRNA(Leu(UUR)) gene was detected, indicating the presence of MELAS. Involuntary movements improved on treatment with haloperidol up to 4.5 mg/day. HCB usually appears in elderly individuals, and cases less than 40-years-old are very rare. The mitochondrial dysfunction in MELAS may accelerate development of HCB.
A 1.8-year-old intact female Maltese dog was presented because of a history of chronic diarrhea, polyphagia, weight loss, and coprophagia. The patient was severely emaciated and evacuated very moist and four-smelling, yellow feces. Fecal stain with Sudan III revealed numerous lipid droplets. Result of fat absorption test showed aldigestion. A definite diagnosis was made based on trypsin-like immunoreactivity assay in serum which was low enough to be diagnosed as an exocrine pancreatic insufficiency. After pancreatic enzyme supplement with porcine pancreatin powder, the clinical signs were disappeared. This case report documents clinical manifestations, diagnostic tools, treatment and efficiency of oral pancreatic enzyme replacement therapy of exocrine pancreatic insufficiency in a Maltese dog.
The author has analyzed the data of 163 patients operated because of their duodenal ulcer disease. There were in existence 30% of the first degree, 53% of the second degree and 17% of third degree emaciated patients. The author developed a new scheme of the enteral feeding. This new scheme proved to be effective based on the analysis of biochemical indices in patients at the early postopeartive period.
We describe a patient with paraneoplastic neurologic syndrome confirmed on postmortem examination. This 42-year-old man was admitted due to general fatigue, emaciation and acute-onset disorientation. Neurological examination revealed disorientation, moderate cognitive impairment, cerebellar ataxia, bilateral limitations and nystagmus in all directions during external ocular movement, swallowing disorder, bilateral Babinski sign, sensory disturbance in the distal parts of all extremities, and Romberg's sign. T-cell lymphoma was diagnosed following biopsy of the cervical lymph node. Neurological condition improved slightly after chemotherapy, but subsequently deteriorated. At about 6 years after the disease onset, brain magnetic resonance imaging (MRI) revealed atrophy of bilateral hippocampi and the upper vermis of the cerebellum. The patient died of pneumonia after a clinical course of about 6 years and 6 months. Pathologically, neuronal loss, reactive gliosis and perivascular lymphocytic infiltration were observed in the hippocampi, cerebellum, and inferior olivary nuclei. Lymphocytes around the vessels were positive for LCA and UCHL-1, but negative for CD8 and L26, and thus were considered to be T cells. No lymphoma cell was observed in the central nervous system or lymphatic organs. Based on the pathological findings, paraneoplastic neurologic syndrome (limbic encephalitis, cerebellar degeneration and olivary pseudohypertrophy) associated with T-cell type malignant lymphoma was diagnosed. Only three other cases of paraneoplastic neurologic syndrome associated with T-cell lymphoma have been reported. In those cases, death occurred due to the deterioration of malignant lymphoma, whereas the present patient died about 6 years after the remission of malignant lymphoma. Prognosis may thus depend on the course of the malignant lymphoma. In the present patient, neurological symptoms deteriorated after remission of malignant lymphoma, and no pathological lesion were found in the lymphatic organs. Lesions in the central nervous system in paraneoplastic neurological syndromes may follow a course independent of the original malignant disease.
Processes of free radical lipid oxidation (FLI), endogenic intoxication, antioxidant protection system (AOP) and morphology of a liver at tetrachlormethane hepatosis and its correction by a complete fasting have been assessed. Two chains of pathogenesis of tetrachlormethane hepatosis have been determined: the metabolic chain that is accompanied by sharp activation of free radical lipid oxidation under emaciation of antioxidant protection system and increasing endotoxemia; and the ischemic chain that enhances the processes of dystrophy and necrosis of hepatocytes and neofibrous formations. The correction by a complete fasting promoted normalization of free radical lipid oxidation at simultaneous rising of antioxidant protection system function, decreasing of a level of endogenic intoxication and conservation of hepatocytes' structure, improving recovering possibilities and prevents dystrophic and necrotic changes and neofibrous formations in the liver at tetrachlormethane hepatosis.
One of the most prevalent pathogens found in zebrafish (Danio rerio) research facilities is the microsporidian parasite Pseudoloma neurophilia. Infections occur primarily in the spinal cord and are associated with emaciation and scoliotic changes. It is unclear why P. neurophilia is so widespread among research colonies, although transfer of infected animals and eggs between laboratories is a likely contributor. In addition to preventing the spread of this pathogen among facilities, it is desirable to have parasite-free fish for use in experiments. Therefore we have developed a polymerase chain reaction (PCR)-based diagnostic test for P. neurophilia. Compared with conventional diagnostic methods, PCR diagnosis is rapid, allows for screening of large numbers of fish, and can be applied to eggs, water filtrates, biofilms, and other samples. Using PCR primers specific to the small subunit ribosomal DNA of P. neurophilia, the test was consistently capable of detecting 10 spores per reaction and often as few as 0.1 spore per reaction, and it did not cross-react with other selected microsporidian species from fish. We recommend this PCR diagnostic assay for use by the research community to determine the presence (or absence) of P. neurophilia in colonies and for screening fish shipped between facilities, especially when parasite-free fish are required for experiments. Furthermore, we currently are using this PCR method to investigate the potential role of vertical transmission in the spread of P. neurophilia.
An emaciated adult African man had a tucked-up upper abdomen caused by an esophageal obstruction, probably due to a malignancy.