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PubMed2006

The microenvironment of vulvar skin in women with symptomatic and asymptomatic herpes simplex virus type 2 (HSV-2) infection.

BACKGROUND: It is not known why some individuals infected with herpes simplex virus type 2 (HSV-2), experience frequent recurrences, while most of those infected have a completely silent infection. OBJECTIVE: We wanted to study if local factors in the skin could explain this difference. DESIGn 21 HSV-2 seropositive patients, 10 with history of >8 clinical recurrences a year (symptomatics) and 11 without symptoms of genital herpes (asymptomatics) were included. All had to answer a questionnaire. With standardised methods, the skin temperature, pH, and the skin barrier function, expressed as transepidermal water loss (TEWL) and skin capacitance, were measured on labium majus and perineum. Culture for bacteria was performed from the same regions. RESULTS AND CONCLUSION: No significant differences in terms of pH and skin barrier function were registered between symptomatic and asymptomatic patients. Asymptomatic patients had a tendency (0.06) to a higher colonisation with lactobacilli on labium majus than symptomatic patients.

Adult↗
PubMed1999

A gonadotrophin-releasing hormone agonist compared with expectant management after conservative surgery for symptomatic endometriosis.

OBJECTIVE: To ascertain whether the frequency of pelvic pain recurrence is reduced and time to symptoms recurrence is prolonged in women with symptomatic endometriosis undergoing conservative surgery and post-operative hormonal therapy compared with women treated with surgery only. Pregnancy rates and time to conception in women wanting children were also evaluated. DESIGN: A multicentre, prospective, randomised controlled study. SETTING: Nineteen Italian academic departments and teaching hospitals specialising in reparative and reconstructive surgery. POPULATION: A total of 269 women undergoing conservative surgery for mild to severe symptomatic endometriosis. METHODS: After surgery the women were assigned to treatment with subcutaneous goserelin depot injections for six months or to expectant management. Dysmenorrhoea, deep dyspareunia, nonmenstrual pain and general discomfort were graded according to a verbal rating scale from 0 (absent) to 3 (severe) and the scores summed to give a total symptoms score. Only patients with at least one preoperative moderate or severe symptom were enrolled. The women were evaluated regularly for two years. MAIN OUTCOME MEASURES: Post-operative pain recurrences (total symptoms scores > or = 5), time to recurrence, pregnancy rates and time to conception in the two study groups. RESULTS: At one- and two-year follow up visits, 14/107 (13.1%) and 19/81 (23.5%) patients had moderate or severe symptoms recurrence in the goserelin group compared with, respectively, 22/103 (21.4%) and 27/74 (36.5%) in the expectant management group (P = 0.143 at 1 year and 0.082 at 2 years). Time to symptoms recurrence was significantly longer in the goserelin group according to survival analysis (Wilcoxon test, P = 0.041). Among women wanting children, few conceptions occurred in both the goserelin (8/69, 11.6%) and the expectant management group (14/76, 18.4%). There was no significant difference at survival analysis (Wilcoxon test, P = 0.427). CONCLUSION: Post-operative treatment with goserelin significantly prolonged the pain-free interval after conservative surgery for symptomatic endometriosis and did not influence reproductive prognosis.

Endometriosis↗
PubMed2000

Prevalence of coronary artery disease, ischemic stroke, and symptomatic peripheral arterial disease and of associated risk factors in older men and women with and without diabetes mellitus.

The authors performed a retrospective analysis of the prevalence of coronary artery disease, ischemic stroke, and symptomatic peripheral arterial disease and of associated risk factors in 99 men (mean age 79±8 years) with diabetes mellitus vs. 368 men (mean age 81±8 years) without diabetes mellitus, and in 260 women (mean age 80±8 years) with diabetes mellitus vs. 1184 women (mean age 81±8 years) without diabetes mellitus. All patients were seen in an academic outpatient geriatrics practice. Diabetic men had a higher prevalence of coronary artery disease, ischemic stroke, and symptomatic peripheral arterial disease (p<0.0001); a higher prevalence of smoking (p=0.023), hypertension (p<0.0001), and obesity (p=0.0007); higher levels of serum total and low density lipoprotein cholesterol (p<0.0001) and triglycerides (p=0.003); and lower levels of serum high density lipoprotein cholesterol (p=0.0001) than men without diabetes mellitus. Diabetic women had a higher prevalence of coronary artery disease, ischemic stroke, and symptomatic peripheral arterial disease (p<0.0001); a higher prevalence of hypertension and obesity (p<0.0001); higher levels of serum total and low density lipoprotein cholesterol (p=0.0001) and triglycerides (p=0.005); and lower levels of serum high density lipoprotein cholesterol (p=0.0001) than women without diabetes mellitus. (c) 2000 by CHF, Inc.

Journal Article↗
PubMedDate not supplied

Prevalence of symptomatic diastolic heart failure in patients hospitalized with cerebral or peripheral vascular disease.

The authors sought to determine the prevalence of diastolic heart failure (DHF) in patients hospitalized with their first stroke, transient ischemic attack, or new onset of peripheral vascular disease. A total of 216 prospective consecutive stroke, transient ischemic attack, and peripheral vascular disease patients (vascular group) were identified at their first noncardiac presentation to a hospital and compared with 164 age-matched control patients (nonvascular group). DHF was clinically defined as the presence of left ventricular ejection fraction>or=45% on echocardiography. DHF occurred in 40% and 73% of vascular and control patients, respectively, with symptomatic heart failure. Overall, it was found in 12% of vascular (10% of stroke/transient ischemic attack, 16% of peripheral vascular disease) and 11% of control patients. Advancing age and female gender were independently associated with the presence of DHF in vascular patients (p<0.05). DHF is found in a similar percentage of vascular and nonvascular patients. Symptomatic DHF is less common than systolic heart failure among vascular disease patients with heart failure. In contrast, symptomatic DHF is found in three times as many age-matched control heart failure patients without clinical vascular disease.

Aged↗
PubMedDate not supplied

Acute and chronic oral magnesium supplementation: effects on endothelial function, exercise capacity, and quality of life in patients with symptomatic heart failure.

Endothelial dysfunction is an important pathophysiologic mechanism in the progression of heart failure. The objective of the present study was to determine the effects of acute and chronic oral magnesium supplementation on endothelial function in patients with symptomatic heart failure. Twenty-two symptomatic chronic heart failure patients were randomized to receive 800 mg oral magnesium oxide daily or placebo for 3 months. Data collected included large and small arterial elasticity/compliance, hemodynamic parameters, exercise capacity, and quality-of-life score at baseline, 1 week, and 3 months. Patients who received magnesium had improved small arterial compliance at 3 months from baseline compared with placebo. This study suggests that chronic supplementation with oral magnesium is well tolerated and could improve endothelial function in symptomatic heart failure patients.

Aged↗
PubMed1995

Incidence of acute symptomatic seizures in Rochester, Minnesota, 1935-1984.

We determined the incidence of seizures due to acute CNS insults for residents of Rochester, Minnesota, U.S.A., from 1935 through 1984. The age-adjusted incidence rates for 1955-1984, the period of most complete case ascertainment, was 39.0/100,000 person-years (United States 1970 population as standard). The age-adjusted incidence was considerably higher in men: 52.0 as compared with 29.5 in women. The 3.6% risk of experiencing an acute symptomatic seizure in an 80-year lifespan approaches that of developing epilepsy. The major causes of acute symptomatic seizures were traumatic brain injury, cerebrovascular disease, drug withdrawal, and CNS infections. Each type of acute symptomatic seizure has age, gender, and time period patterns that reflect the occurrence of the underlying cause.

Adolescent↗
PubMed1998

Symptomatic occipital lobe epilepsy.

Symptomatic occipital lobe epilepsy is increasingly recognized among patients with partial-onset seizures. Although traditional clinical and electroencephalographic criteria had defined occipital lobe epilepsy in the past, new neuroimaging techniques and the recognition of specific syndromes associated with occipital lobe epilepsy have improved the diagnosis and management of these patients. These syndromes include, among others, lesional occipital lobe epilepsy (congenital vs. acquired), MELAS, and epilepsy with bilateral occipital calcifications. The diagnosis of symptomatic occipital lobe epilepsy is improving as functional and structural neuroimaging techniques enable the detection of subtle abnormalities in such patients. This has had a direct impact on the correct classification of patients with benign occipital lobe epilepsy, basilar migraine, and symptomatic occipital lobe epilepsy. The common clinical symptoms, EEG patterns, and neuroimaging findings of these patients are discussed.

Brain Diseases↗
PubMed1999

Gelastic epilepsy: symptomatic and cryptogenic cases.

PURPOSE: To describe the etiology, characteristics, and clinical evolution of epilepsy in patients with gelastic seizures (GSs). METHODS: Nine patients whose seizures were characterized by typical laughing attacks were observed between 1986 and 1997. Patients were selected based on electroencephalogram (EEG) or video-EEG recordings of at least one GS and on magnetic resonance imaging (MRI) study. RESULTS: Five patients were affected by symptomatic localization-related epilepsy (LRE), with four of the patients' disorders related to a hypothalamic hamartoma (HH) and one to tuberous sclerosis (TS) without evident hypothalamic lesions. In four patients (the cryptogenic cases) MRI was negative also in these cases, clinical and EEG data suggested a focal origin of the seizures. The epileptic syndrome in the HH cases was usually drug-resistant, and was surgically treated in two of the patients. The patient with TS became seizure free with vigabatrin. In the cryptogenic cases, the ictal, clinical, and EEG semiology were similar to the symptomatic cases: the clinical evolution was variable, with patients having transient drug resistance or partial response to treatment. No cognitive defects were observed in the cryptogenic patients. None of the nine patients had precocious puberty. CONCLUSIONS: We confirm the frequent finding of HHs in GSs and further underline how GSs may also be observed in patients without MRI lesions and with normal neurologic status. In these patients, clinical and EEG seizure semiology is similar to symptomatic cases, but the clinical evolution is usually more benign.

Adult↗
PubMed2006

Renal transplant recipients are at high risk for both symptomatic and asymptomatic deep vein thrombosis.

BACKGROUND: Venous thromboembolism (VTE) is one of the thrombotic complications that can occur in patients receiving renal transplantation (RT). The prevalence of VTE in RT patients is, however, undefined. OBJECTIVES: To evaluate the rate of a first episode of VTE in a series of 538 consecutive RT recipients admitted to our institution, the timing of occurrence of the thromboembolic events after transplantation, and the rate of recurrence after thromboprophylaxis withdrawal. Risk factors for recurrence were also evaluated, particularly in relation to the type of the first event (symptomatic or asymptomatic). RESULTS: During follow-up, 47 of 518 patients (28 males, 19 females; 9.1%) developed a first episode of VTE at a median time of 17 months (range 1-165 months) after kidney transplantation. Cancer was associated with the occurrence of VTE (odds ratio 4.8). Seventeen of 43 patients (39.5%) with deep vein thrombosis were asymptomatic and the diagnosis was made during routine ultrasound examination. Twenty-two patients (46.8%) experienced a recurrence of VTE. A relevant rate of recurrence was documented amongst patients with a first episode of both symptomatic (53%) and asymptomatic (23.5%) VTE. CONCLUSION: This study confirms that RT patients are at high risk of symptomatic and asymptomatic VTE and that this risk persists even after several years. Patients who experience VTE are at high risk of recurrence after thromboprophylaxis withdrawal.

Adolescent↗
PubMed1983

Atrioventricular and ventriculo-atrial conduction in patients with symptomatic sinus node dysfunction.

In 14 patients with symptomatic sinus node dysfunction--sinus bradycardia, sino-atrial exit block, or sinus arrest--electrophysiological studies were performed before implantation of a pacemaker. In 8 patients incremental high right atrial pacing showed AV-nodal Wenckebach at pacing rates equal to or above 130/min (group I); in 6 patients AV-nodal Wenckebach was reached at pacing rates less than 130/min (group II). During ventricular pacing at a rate 10-15% faster than the existing sinus rate, ventriculo-atrial (VA) conduction was present in all patients of group I, while VA conduction was present in only 2 patients of group II (p less than 0.05). Patients with symptomatic sinus node dysfunction but with intact AV conduction frequently show VA conduction during ventricular pacing and thus are particularly at risk for developing a pacemaker syndrome when a ventricular demand (VVI) pacemaker is implanted. This complication can be avoided by atrial demand (AAI) pacing or AV sequential (DVI) pacing. When adequate experience has been gathered with AV universal (DDD) pacemakers, the indications for selection of a pacemaker in patients with symptomatic sinus node dysfunction will probably change.

Adult↗
PubMed1999

Radiofrequency catheter ablation of symptomatic ventricular ectopic beats originating in the right outflow tract.

Ectopic activity originating in the right ventricular outflow tract is a frequent finding and may result in severe symptoms such as dyspnea, palpitations, and lack of physical capacity correlated with a low cardiac output. In 12 consecutive symptomatic and drug refractory patients, we performed a study with intracardiac mapping and ablation procedure. The origin of the ectopic beats was identified, and the ablation procedure was performed. Patients were examined by serial ECG, Holter ECG, bicycle ECG, echocardiography, and thoracic X ray. At baseline, the mean number of ectopic beats was 23,823 during Holter ECG. No other arrhythmias were present. Patients underwent basic electro-physiological study, mapping process, and ablation in a single procedure. Ablation was performed with a deflectable thermocoupled catheter with tip electrodes of 4 mm. Criteria for identification of the origin of the ectopic beats included pace mapping with 12 leads and earliest endocardial activation. One male patient suffered from myocarditis; the other 11 patients had no underlying structural heart disease. The mean age was 38 years. Ablation procedure with delivered temperature of 70 degrees C was successful in 11 of 12 patients eliminating the focus. The mean procedural time was 79 +/- 34 minutes; mean fluoroscopy time was 13.8 +/- 8.8 minutes; and mean number of applications was 4.4 +/- 2.8. No adverse effects occurred during a follow-up period of 10 months after ablation. The mean number of ectopic beats per 24 hours after ablation was 317 +/- 599 with a P value of 0.00024. The clinical symptoms improved in all but one patient. One patient had a recurrence after 2 months that could be successfully treated by a second procedure. In our experience, temperature guided radiofrequency catheter ablation is safe and effective for the treatment of patients with symptomatic ectopic activity of the right outflow tract. As long as we lack the experience of a greater patient cohort and a longer follow-up, only drug resistant and highly symptomatic patients should be selected.

Adult↗
PubMed2002

Angioplasty and stenting for symptomatic basilar artery stenosis.

A 71-year-old man with symptomatic basilar artery stenosis refractory to antiplatelet therapy and anticoagulation underwent angioplasty and stenting of the basilar artery. The patient was discharged symptom-free on clodiprogel 75 mg qd and aspirin 325 mg qd. One month later, he presented with a right frontal intracerebral hemorrhage. Angioplasty with stenting for symptomatic basilar artery stenosis is feasible. Its role in the therapy of symptomatic basilar artery stenosis is not yet defined. Furthermore, the best medical treatment postprocedure is yet to be established.

Aged↗
PubMed2001

The incidence and clinical characteristics of symptomatic propylthiouracil-induced hepatic injury in patients with hyperthyroidism: a single-center retrospective study.

OBJECTIVES: Although symptomatic propylthiouracil (PTU)-induced hepatic injury is known to be rare, there have been few reports about its exact incidence in patients with hyperthyroidism. We tried to evaluate its incidence in a single center and its clinical course. METHODS: Medical records of 912 hyperthyroid patients who had been diagnosed between March 1990 and December 1998 were reviewed about clinical characteristics, management, and laboratory findings. Symptomatic PTU-induced hepatic injury was defined as the development of jaundice or hepatitis symptoms with at least a 3-times elevation of liver function tests (LFT) without other causes. RESULTS: Four hundred ninety-seven patients (age 42.6 +/- 10.7 yr, male/female 140/357) were included. Clinically overt hepatitis developed in six patients (1.2%; age, 43.7 +/- 14.8 yr; male:female ratio, 3:3) between 12 and 49 days after PTU administration. Jaundice and itching developed in five patients, fever in two, rash in two, and arthralgia in one. Bilirubin, ALT, and ALP increased in five, four, and six patients, respectively (293 +/- 288 micromol/L, 143 +/- 111 U/L, and 265 +/- 81 U/L; normal, < 117 U/L). The type of hepatic injury was cholestatic in three, hepatocellular in one, and mixed in two patients. None resulted from viral hepatitis. There were no statistical differences in age, sex, PTU dose, or T4 and T3 levels at initial diagnosis between patients with and without hepatic injury. LFT normalized in all patients between 16 and 145 (72.8 +/- 46.4) days after the PTU withdrawal. CONCLUSIONS: Symptomatic hepatic injury develops usually within the first few months of PTU administration with rare frequency, but its clinical course is relatively benign once the drug is withdrawn. However, it may be difficult to predict its development, so all patients should be monitored for rise in LFTs at regular intervals, especially during the early period.

Adult↗
PubMed2004

Multichannel electrogastrography (EGG) in symptomatic patients: a single center study.

OBJECTIVES: To determine the value of multichannel versus conventional single-channel electrogastrography (EGG) and of an additional postprandial hour recording in symptomatic patients. METHODS: Eighteen normal subjects and 47 patients with upper GI symptoms underwent multichannel EGG with four cutaneous recording electrodes placed on the antral axis. Fasting EGG was recorded for 1 h, followed by meal ingestion, followed by two 1-h postprandial EGG recordings. Variables assessed: (1) dominant frequency (DF) and its power; (2) percent time in normal (2-4) cpm frequency; (3) average percent of slow wave coupling (% SWC). RESULTS: Normal values for single-channel EGG were: (1) DF from 2.5-3.3, 2.7-3.5, and 2.6-3.5 cpm in the fasting, first, and second postprandial hours; (2) percentage of time in 2-4 cpm: >50%, >65%, and >65% in the fasting, first, and second postprandial hours. Normal values for percent SWC using multichannel EGG were >50%, >55%, >55% in the fasting, first, and second postprandial hours. In the symptomatic patients, an abnormal 2-h single-channel EGG was obtained in 16 of 47 (34%) patients. Adding an additional 1 h of postprandial recording identified another 4 abnormal patients (20/47 = 43%). With multichannel EGG, abnormal results were obtained in 24 of 47 patients (51%) with the 2-h study. An additional 1 h of postprandial recording identified another 4 patients as abnormal (28/47 = 60%). CONCLUSIONS: Multichannel EGG recording improved the detection of abnormal gastric myoelectric activity in symptomatic patients. This study also demonstrates prolonging the postprandial recording to 2 h increases the diagnostic yield for both single-channel and multichannel EGG.

Adult↗
PubMed1999

Correlation between symptomatic, radiological and etiological diagnosis in acute ischemic stroke.

OBJECTIVES: The aim of this study was to correlate with the symptomatic, radiological and etiological diagnosis in acute ischemic stroke. SUBJECTS AND METHODS: Two hundred and fifty patients with first-ever ischemic stroke within 24 h of onset were prospectively studied with 3-step diagnoses: 1) symptomatic diagnosis based on the Oxfordshire Community Stroke Project criteria (OCSP), 2) radiological diagnosis (CT or MRI) and 3) etiological diagnosis based on the Lausanne Stroke Registry criteria. RESULTS: Most of the patients with symptoms of total anterior circulation infarcts (TACI), partial anterior circulation infarcts (PACI) and posterior circulation infarcts (POCI) had corresponding lesions on CT or MRI, while only 68% of lacunar infarcts (LACI) patients had small subcortical infarction (SSI). More than 60% of patients with TACI were classified into cardioembolism in the third diagnosis, while the etiology of PACI was either CE or large-artery atherosclerosis (LAA) in equal numbers. Only 58% of LACI patients were classified into small-artery disease (SAD) and 29% of them (30 cases) into LAA, of which 23 patients had lesions other than SSI. The positive predictive value of SAD in the combination of LACI and SSI was 0.78. The etiology of POCI was variable. CONCLUSION: Except for LACI, the symptomatic classification by OCSP corresponds well to the radiological diagnosis. The etiological diagnosis can be predicted by OCSP in TACI and PACI, but it is hard in POCI, and a number of LACI are due to LAA.

Adult↗
PubMed2005

A homozygous nonsense mutation (428G-->A) in the human secretor (FUT2) gene provides resistance to symptomatic norovirus (GGII) infections.

Noroviruses (formerly Norwalk-like viruses) are a major cause of acute gastroenteritis worldwide and are associated with a significant number of nosocomial and food-borne outbreaks. In this study we show that the human secretor FUT2 gene, which codes for an alpha(1,2)-fucosyltransferase synthesizing the H-type 1 antigen in saliva and mucosa, is associated with susceptibility to norovirus infections. Allelic polymorphism characterization at nucleotide 428 for symptomatic (n = 53) and asymptomatic (n = 62) individuals associated with nosocomial and sporadic norovirus outbreaks revealed that homozygous nonsense mutation (428G-->A) in FUT2 segregated with complete resistance for the disease. Of all symptomatic individuals, 49% were homozygous (SeSe) and 51% heterozygous (Sese428) secretors, and none were secretor negative (se428se428), in contrast to 20% nonsecretors (se428se428) among Swedish blood donors (n = 104) (P < 0.0002) and 29% for asymptomatic individuals associated with nosocomial outbreaks (P < 0.00001). Furthermore, saliva from secretor-positive and symptomatic patients but not from secretor-negative and asymptomatic individuals bound the norovirus strain responsible for that particular outbreak. This is the first report showing that the FUT2 nonsecretor (se428se428) genotype is associated with resistance to nosocomial and sporadic outbreaks with norovirus.

Caliciviridae Infections↗
PubMed2001

Symptomatic rickets in adolescence.

AIM: To describe 21 cases of symptomatic rickets in adolescents. METHODS: The setting was a primary and secondary care hospital in Saudi Arabia providing medical care to Saudi Arab company employees and their families. Cases of symptomatic rickets diagnosed between January 1996 and December 1997 in adolescents aged 10 to 15 years were assessed with respect to clinical presentation, biochemical and radiological evaluation, dietary assessment, and estimation of sun exposure. RESULTS: Symptomatic rickets developed in 21 adolescents (20 females), with a prevalence rate of 68 per 100 000 children years. Presentation included carpopedal spasms (n = 12), diffuse limb pains (n = 6), lower limbs deformities (n = 2), and generalised weakness (n = 1). Biochemical findings included hypocalcaemia (n = 19), hypophosphoraemia (n = 9), raised serum alkaline phosphatase (n = 21) and parathormone (n = 7), and reduced 25-hydroxyvitamin D concentrations (n = 7). Radiological studies were suggestive of rickets in only eight children. All children had an inadequate dietary calcium and vitamin D intake. All but one had less than 60 minutes sun exposure per day. CONCLUSION: Even in sunny climates, adolescents, especially females, can be at risk of rickets. Hypocalcaemic tetany and limb pains were the most common presenting symptoms. Radiological evidence was not present in every case.

25-Hydroxyvitamin D 2↗
PubMed1991

Study of 500 patients with limb joint osteoarthritis. I. Analysis by age, sex, and distribution of symptomatic joint sites.

Five hundred subjects with symptomatic limb joint osteoarthritis, who had been referred to a rheumatologist, were enrolled into a continuing study. They comprised 342 women (mean age 65.3) and 158 men (mean age 59.7), with a mean symptom duration of 15.4 years at entry. Only 31 patients (6%) had symptomatic osteoarthritis of one joint alone; however, in a further 205 (41%) the disease was limited to one site. One hundred and eighty two (36.4%) had two sites affected and 82 (16.4%) three or more sites of symptomatic osteoarthritis. Of 847 affected joints the most commonly involved were 349 (41.2%) knees, 254 (30%) hands, and 161 (19%) hips. Hip disease stood out as a separate entity, often occurring alone, and having a stronger male preponderance and different associations than osteoarthritis at other joint sites. Knee and hand disease were significantly associated in women. Obesity, hypertension, and Heberden's nodes were common. The number of sites affected, as well as the distribution, was strongly related to age as well as sex, suggesting that polyarticular osteoarthritis arises from slow acquisition of new joint sites in a non-random distribution. 'Generalised' osteoarthritis did not emerge as a distinct entity.

Age Factors↗