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PubMed1997

Stressful life events and risk of symptomatic kidney stones.

BACKGROUND: It has been reported that a substantial proportion of cases of hypercalciuria and nephrolithiasis are idiopathic. Several studies suggested that stressful life events increase lithogenic urinary constituents (calcium, oxalate and uric acid). OBJECTIVE: To test the hypothesis that there is an association between stressful life events and symptomatic kidney stone. METHODS: A case-control study of 200 symptomatic kidney stone cases and 200 matched controls was designed to test the hypothesis. In this study, the stressors include those life events that the subjects perceived as highly stressful and inflicted upon them an intense emotional impact with apprehension and distress for at least one week in duration. RESULTS: Ten of eleven (91%) categories and 41 of 60 (68%) subcategories of stressful events occurred more frequently among cases than controls. Eighteen stressful events had odds ratios of 1.5 or greater. Of the seven significant (P < 0.05) variables that were entered into a multivariate logistic regression model, the following three remained statistically significant between cases and controls: annual family income (lower for cases); stressful morgage problems; and emotional life events. CONCLUSION: The overall prevalence rate of stressful life events was significantly (P < 0.00001) higher among cases than controls. The data support the hypothesis that there is an association between stressful life event(s) and symptomatic kidney stones.

Adolescent↗
PubMed1993

Blastocystis hominis: prevalence in asymptomatic versus symptomatic hosts.

Blastocystis hominis, other protozoans, and fecal leukocytes were tabulated on trichrome-stained fecal smears from 182 asymptomatic and 125 symptomatic control patients. No statistically significant difference in prevalence of B. hominis was found between the asymptomatic study group and the symptomatic control group; the clinical profile of subjects with B. hominis and those not infected was similar, and no correlation was found between the presence of B. hominis and that of fecal leukocytes. High concentrations of B. hominis were more frequent and more nonpathogenic protozoa were found in symptomatic patients than in those who were asymptomatic.

Adolescent↗
PubMed1994

Quantitative analysis of viral burden in tissues from adults and children with symptomatic human immunodeficiency virus type 1 infection assessed by polymerase chain reaction.

The amount of human immunodeficiency virus type 1 (HIV-1) in various tissues was investigated by polymerase chain reaction (PCR) in 16 patients with end-stage HIV-1 infection and 7 patients with symptomatic but less advanced disease. During postmortem study of the 16 end-stage patients, HIV-1 DNA was found most often in lymph nodes and the spleen (both 100%), lung (93.8%), and colon (87.5%). Biopsied lymph nodes from the 7 symptomatic patients contained substantially higher copy numbers of HIV-1 RNA and DNA than did peripheral blood mononuclear cells (PBMC). Plasma viral RNA levels correlated significantly with the amount of HIV-1 RNA in PBMC (r2 = .86, P = .0025) but not with the level of viral RNA in lymph nodes in patients with symptomatic HIV-1 infection. These data suggest that although lymph nodes represent the main site for HIV-1 infection and replication, the level of circulating viral burden may not be solely determined by the magnitude of active HIV-1 replication in lymph nodes.

Acquired Immunodeficiency Syndrome↗
PubMed1997

Asymptomatic and symptomatic cryptosporidiosis: their acute effect on weight gain in Peruvian children.

This study investigated whether a child's first infection with Cryptosporidium parvum had an acute effect on weight gain. Specifically, the authors compared monthly rates of weight gain between C. parvum-infected and noninfected children. Over a 2-year period (1989-1991), a cohort of Peruvian children aged 0-3 months at recruitment were followed twice weekly for assessment of daily diarrheal status, weekly for C. parvum stool examinations, and monthly for anthropometric measurements. Data on 207 children permitted the authors to examine the effect of C. parvum infection on weight gain. During the 2-year study period, 45% (94/207) of the children became infected with C. parvum for the first time. Weight gain intervals in 57 of the 94 infected children met criteria for analysis. Of these, 63 percent (36/57) were asymptomatic (i.e., had no diarrhea). On average, children with symptomatic cryptosporidiosis gained (i.e., grew) 342 g less (95% confidence interval 167-517) during the first month of infection than did children without diarrhea who were not yet infected. The effect of asymptomatic cryptosporidiosis was less severe: On average, children with asymptomatic infection gained 162 g less (95% confidence interval 27-297) during the first month of infection than did children without diarrhea who were not yet infected. Symptomatic cryptosporidiosis retarded weight gain more than did asymptomatic cryptosporidiosis, but the latter was twice as common. Since asymptomatic cryptosporidiosis is more prevalent, it may have more of an overall adverse effect on child growth in the community than symptomatic cryptosporidiosis.

Acute Disease↗
PubMed1993

Biochemical modulation of 5-fluorouracil: a randomized comparison of sequential methotrexate, 5-fluorouracil and leucovorin versus sequential 5-fluorouracil and leucovorin in patients with advanced symptomatic colorectal cancer. The Nordic Gastrointestinal Tumor Adjuvant Therapy Group.

BACKGROUND: The optimal chemotherapy for advanced colorectal carcinoma is not known. Two regimens, both based upon biochemical modulation of 5-FU, were compared in a randomized multicenter trial. PATIENTS AND METHODS: A total of 202 symptomatic patients were randomly allocated to receive either sequential methotrexate, 250 mg/m2, during the first 2 hours and 5-FU, 500 mg/m2, at hours 3 and 23 followed by leucovorin rescue initiated at hour 24 (15 mg x 8) (MFL) or sequential 5-FU 500 mg/m2 followed by leucovorin 60 mg/m2 30-40 minutes later, on days 1 and 2 (FLv). Treatments were repeated every 14 days for eight courses and then every 3 to 4 weeks. Four patients were unevaluable. RESULTS: The two treatments were equally effective with respect to objective response rates (complete (CR)+partial (PR), MFL 17%, FLv 21%), subjective response rates (symptom relief in the absence of severe adverse effects, 45% vs. 37%), and survival (median 7.5 vs. 9 months). All responses lasted at least 4 months. Overall, toxicity was low and comparable between the groups, but serious toxicity was more common in the MFL group. CONCLUSIONS: Since FLv is easier to administer and carries less risk for serious toxicity, it should be recommended as a first-line treatment before MFL. On either regimen, about 40% of symptomatic patients can expect palliation, i.e., symptomatic relief without severe adverse effects, for at least 4 months.

Adult↗
PubMed1997

Accessory atrioventricular pathways with only antegrade conduction in patients with symptomatic Wolff-Parkinson-White syndrome. Clinical features, electrophysiological characteristics and response to radiofrequency catheter ablation.

Information about accessory pathways conducting only in the antegrade direction is limited. The purposes of the present study were to prospectively investigate the clinical features, electrophysiological characteristics, effects of radiofrequency catheter ablation and recurrent atrial fibrillation after successful ablation in patients with accessory pathways conducting only in the antegrade direction, and to compare them with those who had pathways capable of bidirectional conduction in a consecutive series of 759 patients. Electrophysiological studies and radiofrequency catheter ablation were performed in 33 study patients with antegrade-only accessory pathways and in 377 patients with bidirectional accessory pathways for comparison. The patients with accessory pathways conducting only in the antegrade direction were older (47 +/- 16 vs 40 +/- 16 years, P = 0.037) and had a higher incidence of atrial fibrillation (100% vs 27.1%, P < 0.001) as well as related syncope (33.3% vs 10.1%, P = 0.001). The study patients also had more accessory pathways located in the posterior septum and a higher incidence of retrograde atrioventricular nodal conduction. The biophysical variables, success and complication rates of radiofrequency ablation were similar in both groups. During the follow-up period of 32 +/- 12 months, symptomatic atrial fibrillation after successful ablation did not recur in 79% and 81% of patients with unidirectional and bidirectional accessory pathways, respectively. Furthermore, old age and cardiovascular diseases were independent predictors of recurrent atrial fibrillation after radiofrequency ablation. In conclusion, this study showed that atrial fibrillation with preexcitation was the usual presentation in patients who had symptomatic Wolff-Parkinson White syndrome with an antegrade-only accessory pathway, and might be related to antegrade conduction of the accessory pathway. Therefore elimination of antegrade-only and bidirectional pathways by radiofrequency ablation could prevent the recurrence of symptomatic atrial fibrillation in younger patients without cardiac disease.

Adult↗
PubMed1989

Cost-benefit analysis of medical vs surgical treatment of symptomatic patients with accessory atrioventricular pathways.

Surgical treatment of patients with an accessory atrioventricular pathway leading to symptomatic arrhythmias provides effective control. However, surgical treatment is usually considered only when medical treatment fails. To assess the cost-benefit ratio of medical vs surgical treatment 77 patients treated with antiarrhythmic drugs were compared with 50 patients treated surgically. Cost was calculated by considering current costs for drugs, surgery and pacemakers, electrophysiological investigations, outpatient clinic controls, and costs of readmissions because of tachycardia. Mean cost per treated patient and mean cost per successfully treated patient (total cost divided by the number of patient not requiring readmission during follow-up) was respectively 4242 and 6949 US dollars after 56 months for the medically treated group and 10800 and 11250 US dollars for the surgically treated group. A projection of costs demonstrated that costs of medical treatment was the same as costs of surgical treatment after 12.5 years of treatment but a higher number of medically treated patients remain symptomatic. We conclude that surgical treatment of symptomatic patients with accessory pathways has a better cost-benefit ratio than medical treatment and should be considered earlier without waiting for failure for medical treatment.

Adolescent↗
PubMed1988

Characteristics of transient ischaemic episodes in patients with silent and symptomatic exercise-induced myocardial ischaemia.

To evaluate transient ischaemic episodes during daily life in patients with coronary artery disease and exercise-induced myocardial ischaemia, 38 patients underwent ambulatory ST-segment monitoring over 48 h. Sixteen patients had painless ischaemia during exercise and occasional angina, and 12 patients had symptomatic ischaemia and frequent angina during daily life. Ten patients with proven coronary artery disease but normal exercise electrocardiograms served as controls. The extent of coronary artery lesions and the prevalence of myocardial infarction were similar in all groups. ST-segment monitoring revealed 817 min and 98 episodes of ST depression in 13/16 patients of the asymptomatic group and 111 min and 21 episodes in 5/12 patients of the symptomatic group (P less than 0.03). Subjective scores for physical activity during Holter monitoring were significantly higher in the first group than in the second. The majority of ischaemic episodes in both groups was asymptomatic. No ischaemic ST changes occurred in control patients. Results indicate a higher frequency of transient ischaemic episodes related to a higher level of physical activity in patients with silent ischaemia than in patients with symptomatic exercise-induced ischaemia.

Angina Pectoris↗
PubMed2003

Leisure time physical activity and coronary heart disease mortality in men symptomatic or asymptomatic for ischaemia: evidence from the Whitehall study.

BACKGROUND: Although numerous studies have shown an association between physical activity and coronary heart disease (CHD) mortality in healthy persons, few have reported on this relation in individuals with pre-existing diseases, such as ischaemia. Further, we are unaware of any study to examine if this relationship is modified by the symptomatic nature of the ischaemia. METHODS: To explore these issues, we analysed data from a 25 year follow-up of mortality for 6474 male British civil servants who underwent a resting electrocardiogram and responded to queries regarding angina at study entry. RESULTS: Among men who had ECG abnormalities but no angina (i.e. asymptomatic), activity was associated with a higher rate of CHD mortality. Among men with both angina and ECG abnormalities (i.e. symptomatic), activity was associated with lower CHD mortality but this was not statistically significant at conventional levels. CONCLUSIONS: In the present study, there was a suggestion that the symptomatic nature of ischaemia appeared to modify the effect of physical activity on total and CHD mortality. Although these findings should be examined in other studies, they point to the need for a pre-participation medical examination in active persons or those contemplating embarking on an activity programme.

Adult↗
PubMed2001

Prevalence of vertebral deformities and symptomatic vertebral fractures in corticosteroid treated patients with rheumatoid arthritis.

OBJECTIVE: This study was designed to determine whether the prevalence of vertebral deformities in patients with rheumatoid arthritis (RA) treated with corticosteroids (Cs) is higher than in RA patients not receiving Cs therapy. PATIENTS AND METHODS: This multicentre cross-sectional study included 205 patients with RA who were receiving Cs orally on a daily basis and 205 patients with RA who did not receive Cs, matched for sex and age. Vertebral deformities were scored according to the Kleerekoper method. RESULTS: Vertebral deformities were found in 52 (25%) patients on Cs and in 26 (13%) patients not on Cs. Sixteen (8%) patients in the group on Cs had experienced clinical manifestations of an acute vertebral fracture in the past vs only three patients (1.5%) among those not on Cs. The use of Cs tended to increase the risk of developing a vertebral deformity [adjusted odds ratio (OR) 1.56, 95% confidence interval (CI) 0.81-2.99] and symptomatic vertebral fracture (adjusted OR 1.42, 95% CI 0.24-8.32). Each 1-mg increase in the current daily Cs dose increased the risk of a vertebral deformity (adjusted OR 1.05, 95% CI 0.98-1.13) and of a symptomatic vertebral fracture (adjusted OR 1.05, 95% CI 0.89-1.24). CONCLUSION: There is a higher prevalence of vertebral deformities and clinical manifestations of vertebral fractures in patients on Cs than in those not on Cs. Our data indicate that the use of Cs and each 1-mg increase in the current daily Cs dose may increase the risk of development of a vertebral deformity and symptomatic vertebral fracture in patients with RA.

Aged↗
PubMed1991

Comparison of stainable liver iron between symptomatic and asymptomatic hemochromatosis homozygotes and their homozygous relatives.

The authors compared the amount of hepatic parenchymal cell stainable iron in 159 hemochromatosis homozygotes. They were separated into four groups. Group 1: 59 symptomatic hemochromatosis probands with hemochromatosis (mean age 49 years) who were identified because of symptoms and signs of iron overload. Group 2: 38 asymptomatic probands with hemochromatosis (mean age 29 years) identified during population screening studies or during routine health maintenance evaluation. Group 3: 47 homozygous relatives (mean age 43 years) of Group 1 probands. Group 4: 15 homozygous relatives (mean age 30 years) of Group 2 probands. The symptomatic probands (Group 1) were 20 years older and had much more stainable hepatic iron (p less than 0.0001) than the asymptomatic probands (Group 2). The homozygous relatives (Group 3) of the symptomatic probands also were older and had much more stainable hepatic iron than the homozygous relatives (Group 4) of asymptomatic probands (p less than 0.0002). The results of this study suggest that population screening studies can result in early identification of individuals with hemochromatosis before massive hepatic iron overload occurs and before symptoms of iron overload develop.

Hemochromatosis↗
PubMed1994

Two-staged breast reconstruction in patients with symptomatic macromastia requiring mastectomy.

Patients with symptomatic macromastia undergoing mastectomy for the treatment of malignant breast disease are candidates for a two-staged operation resulting in breast reconstruction and contralateral breast reduction. Five patients with symptomatic macromastia underwent a skin-sparing mastectomy for breast disease using a modified Wise incision. The first stage of the breast reconstruction was performed with a de-epithelialized transverse rectus abdominis musculocutaneous (TRAM) flap. Second-stage breast reconstruction was conducted 4 to 6 months later when revision of the TRAM reconstructed breast and concurrent contralateral breast reduction were performed with the intent of tailoring the reduced breast to approximate the revised TRAM breast mound. Excess areola from the reduced breast was harvested and used as a full-thickness graft to reconstruct the TRAM areola complex. Patients followed for 5 to 30 months postoperatively confirm resolution of macromastia symptoms, correction of the mastectomy defect, and symmetrical breast mound creation in a timely two-staged procedure. The two-staged breast reconstruction described represents an expedient plan for patients with symptomatic macromastia requiring mastectomy for breast disease. Skin-sparing mastectomy, modified Wise pattern incisions, utilization of usually discarded areola tissue, and creation of symmetrical breast mounds during the second stage of the reconstruction highlight the salient features of this patient management paradigm.

Adult↗
PubMed1984

Symptomatic malignant melanoma of the gastrointestinal tract. Operative treatment and survival.

Malignant melanoma involving the gastrointestinal tract is a common autopsy finding in patients who die with this disease. Melanoma metastatic to bowel infrequently causes symptoms. Some investigators suggest that survival following the onset of gastrointestinal symptoms is very poor and, as a result, surgical intervention to relieve symptoms should be avoided. We reviewed the clinical courses of 15 consecutive patients with symptomatic malignant melanoma of the bowel who underwent resection alone or in combination with bypass of symptomatic intestinal lesions. There were no deaths within 30 days of operation; 14 patients obtained relief of intestinal symptoms; 11 patients survived a mean of 7.9 months; and four patients are alive 2, 7, 22, and 23 months after operation. These results suggest that operations to treat symptomatic intestinal melanoma provide reasonable palliation and survival for patients with this disease.

Adult↗
PubMed1985

The natural history of diagnosed gallstone disease in symptomatic and asymptomatic patients.

The natural history of gallstone disease in 691 patients, followed for a mean +/- SD duration of 78 +/- 61.6 months (median 62.9 months), is presented. These patients are all subscribers of a large health maintenance organization and are believed to represent a cross-section of middle income Americans. Symptoms attributed to biliary tract disease were present in 556 (80.5%), and the other 135 (19.5%) patients were asymptomatic. In the symptomatic group, the mean +/- SD duration of observation was 82.9 +/- 63.2 months (median 68.5 months); 242 (44%) eventually underwent biliary tract operations most often because of persistent symptoms. Only 10% of asymptomatic patients followed for 58 +/- 50.2 months (median 46.3 months) developed symptoms of biliary calculi, and seven per cent required operations. There were 50 deaths in this series of 691 patients, 25 in the symptomatic group, and 25 in the asymptomatic. Only two of these deaths were biliary tract related, and both were in the symptomatic group. This study suggests that patients with silent stones do not need to be operated on prior to the development of symptoms. In addition, many patients with symptoms of biliary calculi can tolerate their symptoms for long periods of time and prefer this course of action to cholecystectomy.

Adult↗
PubMed1994

Laparoscopic management of symptomatic nonparasitic cysts of the liver. Indications and results.

OBJECTIVE: This clinical study evaluated the results of and defined the indications for laparoscopic fenestration of symptomatic nonparasitic hepatic cysts, either solitary or diffuse. SUMMARY BACKGROUND DATA: Different surgical treatments have been proposed for highly symptomatic hepatic cysts: enucleation, fenestration, hepatic resection, and liver transplantation. The advent of laparoscopic surgery has given new opportunities but, at the same time, has increased the uncertainties concerning the proper management of these patients. METHODS: Eight patients with solitary cysts and nine with polycystic liver and kidney disease (PLD) were seen during a period of 2 years. After a careful review of the symptoms, 6 patients were excluded from surgical treatment and 11 (4 solitary cysts and 7 PLD) were treated by laparoscopic fenestration. Postoperative morbidity and mortality rates, hospital stay, and clinical early and late results were evaluated. RESULTS: In the solitary cyst group, there was no surgical morbidity or deaths, and a complete regression of symptoms occurred in all patients. No recurrences were observed. In the PLD group, two patients had to be converted to laparotomic fenestration (28%). There were no deaths, and the surgical morbidity was limited to two cases of postoperative ascites. Symptomatic relief was obtained in 80% of patients, but the symptoms recurred in 60%. A subgroup of PLD at high risk for recurrence was identified. CONCLUSIONS: The best indications for laparoscopic fenestration seem to be solitary cyst and PLD characterized by large cysts mainly located on the liver surface (type 1), whereas PLD characterized by numerous small cysts all over the liver (type 2) should be considered a contraindication to laparoscopic fenestration.

Adult↗
PubMed1999

Prospective comparison of standard triple assessment and dynamic magnetic resonance imaging of the breast for the evaluation of symptomatic breast lesions.

OBJECTIVE: To compare the sensitivity and specificity of the traditional triple assessment of symptomatic breast lesions with contrast-enhanced dynamic magnetic resonance imaging. BACKGROUND: Although triple assessment is currently the gold standard for the assessment of symptomatic breast disease, its specificity is such that open biopsies are still required in many cases to be confident of the diagnosis. Contrast-enhanced dynamic magnetic resonance imaging of the breast represents an alternative diagnostic modality. METHODS: Patients were recruited from the symptomatic breast clinics. If any of the diagnostic modalities suggested malignancy, the lesion was excised. The remaining patients were followed clinically and radiologically. RESULTS: Two hundred eighty-five patients with a mean age of 43 years (range 21 to 77) were recruited. Malignant lesions were excised in 131 patients and benign lesions in 55 patients. The 99 patients who did not undergo surgery were followed clinically and radiologically for a median of 20 months. The sensitivity of each modality was as follows: clinical examination 84%, mammography 87.6%, fine-needle aspiration cytology 79.1%, triple assessment 99.2%, and magnetic resonance imaging 99.2%. In addition, histologically confirmed multifocal disease was detected in 40 patients on magnetic resonance imaging but in only 9 (22.5%) on mammography. The specificity for the diagnosis of benign disease was as follows: clinical examination 83.1%, ultrasound 88.9%, mammography 86.4%, fine-needle aspiration cytology 97%, triple assessment 59.1%, and magnetic resonance imaging 90.9%. CONCLUSION: Contrast-enhanced dynamic magnetic resonance imaging of the breast is as sensitive and more specific than the combined traditional triple assessment for the diagnosis of malignant breast lesions.

Adult↗
PubMed1993

Neuropsychological performance in symptomatic and asymptomatic HIV infection.

OBJECTIVE: To examine cognitive function in patients at various stages of HIV infection, and to determine the nature and severity associated with stage of illness. DESIGN: Subjects were administered an extensive battery of neuropsychological tests. SUBJECTS: Two hundred and thirty-three HIV-1-infected homosexual/bisexual men and 77 HIV-negative control subjects who had been screened for previous neurological illness. All subjects were volunteers in a longitudinal study of neurobehavioral complications of HIV infection. RESULTS: Patients with symptomatic infection differed from controls on a large number of measures, and asymptomatic patients had a more circumscribed pattern of deficit. On a summary measure of cognitive impairment, there was a twofold increase in the prevalence of impairment in asymptomatic patients relative to controls, and a fourfold increase in symptomatic patients. Memory and dexterity problems appear to be early features of neurobehavioral dysfunction, and frontal lobe deficits were found in patients with symptomatic infection. CONCLUSION: These data indicate that there is a steady increase in the prevalence of neurobehavioral abnormalities associated with stage of infection. The pattern of abnormality also varies with disease stage.

Acquired Immunodeficiency Syndrome↗
PubMed1993

High levels of circulating RNA in patients with symptomatic HIV-1 infection.

OBJECTIVE: To evaluate the concentration of circulating RNA (viraemia) in patients with symptomatic primary HIV infection and relate it to sero-immunological parameters. METHODS: Semiquantitation of circulating HIV RNA and proviral HIV DNA was performed using the polymerase chain reaction. Circulating HIV RNA concentrations were expressed as virus equivalent (RNA copies/2) per ml serum. RESULTS: The mean CD4+ lymphocyte count for 19 patients with symptomatic primary HIV infection was 583 x 10(6)/l. Fifteen (79%) patients had detectable levels of p24 antigen (median 462 pg/ml). Circulating HIV RNA (median 2.3 x 10(7) virus equivalent/ml serum) and proviral HIV DNA (median 3630 copies/ml blood) were detected in all samples tested. Follow-up data for five patients (200-1600 days) showed a 1-3 log reduction in circulating RNA within 2 months. Later, circulating RNA concentrations were consistently greater than 10(3) virus equivalent/ml serum. Within 10 days no p24 antigen was detectable. Levels of CD4+ cells varied markedly from patient to patient during the follow-up and, in this small group, no evident correlation was observed between circulating RNA levels and CD4+ lymphocyte counts. CONCLUSIONS: High concentrations of circulating RNA (viraemia) were present in 19 patients with symptomatic primary HIV infection. Although a decrease in viraemia was observed during the following 2 months, viraemia persisted in all patients with long-term follow-up. This suggests that active viral replication is a continuous process in HIV-infected patients.

Adult↗