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PubMed1994

Usefulness of mean aortic valve gradient and left ventricular diastolic filling pattern for distinguishing symptomatic from asymptomatic patients.

Consecutive, symptomatic (n = 15) and asymptomatic (n = 25) men with aortic stenosis (valve area < 1.2 cm2) and no clinical evidence of myocardial ischemia underwent radionuclide angiography at rest and during supine bicycle ergometry. Ejection fraction, diastolic filling pattern and aortic valve area/gradient were measured on enrollment and when patients became symptomatic (n = 10) or underwent valve replacement (n = 22) during a 2-year follow-up period. Both groups had similar heart rate, blood pressure and ejection fractions, but mean aortic gradients were higher in symptomatic (53 +/- 4 mm Hg) than asymptomatic (37 +/- 2 mm Hg) subjects p < 0.01. Functional limitation evoked by exercise was prevalent even in the asymptomatic group but symptomatic patients exercised to lower work levels than asymptomatic subjects (184 +/- 27 and 307 +/- 32 kg.m/min, respectively, p = 0.02). Ejection fraction failed to increase with exercise in either group. Symptomatic subjects had supranormalization of early diastolic filling with shorter time to the peak filling rate than asymptomatic subjects (137 +/- 16 and 172 +/- 9 ms, respectively, p < 0.05) and a greater first 1/3 filling fraction. The 10 patients who became symptomatic during follow-up had higher first 1/3 filling fractions (53 +/- 7 and 42 +/- 5%, respectively) and mean gradients (41 +/- 4 and 33 +/- 2 mm Hg, respectively) than subjects who remained asymptomatic, p < 0.05. High mean aortic gradients, impaired exercise tolerance and enhanced early diastolic filling distinguish symptomatic from asymptomatic patients.

Adult↗
PubMed1995

A prospective study of alcohol, smoking, caffeine, and the risk of symptomatic diverticular disease in men.

The relationship between smoking, caffeine, and alcohol intake and the risk of symptomatic diverticular disease has not been investigated directly. We examined these associations in a prospective cohort of 47,678 US men, 40 to 75 years old. During 4 years of follow-up (1988 to 1992), we documented 382 newly diagnosed cases of symptomatic diverticular disease. After adjustments for age, physical activity, and energy-adjusted intake of dietary fiber and total fat, alcohol intake (comparing those who drink > 30 g of alcohol/d to nondrinkers) was only weakly and nonsignificantly associated with risk of symptomatic diverticular disease (relative risk (RR) = 1.36; 95 percent confidence interval (CI), 0.94 to 1.97; P for trend = 0.37). We observed no association between caffeine, specific caffeinated beverages, and decaffeinated coffee and the risk of symptomatic diverticular disease. Current smoking was not appreciably associated with risk of symptomatic diverticular disease compared to nonsmokers (RR = 1.25; 95 percent CI, 0.75 to 2.09) after adjustment for age, physical activity, and energy-adjusted intake of dietary fiber and total fat. In a subset analysis restricted to men who had undergone sigmoidoscopy or colonoscopy, a modest positive association was seen between smoking and risk of symptomatic diverticular disease. These results suggest that smoking, caffeine, and alcohol intake are not associated with any substantially increased risk of symptomatic diverticular disease.

Adult↗
PubMed2006

Obstetric risk factors for symptomatic prolapse: a population-based approach.

OBJECTIVE: The purpose of this study was to identify obstetric risk factors for symptomatic prolapse. STUDY DESIGN: This was a population-based case-control study of prolapse prevalence. RESULTS: Four hundred fifty-four women with self-reported symptomatic pelvic organ prolapse who were identified among 5489 women who participated in a population survey (cases) and 405 control subjects without symptoms were selected randomly from the same survey. All cases and control subjects received a mailed questionnaire with 72 questions about factors that were suspected to be linked to risk and that included obstetric history. The response rate was 76%. Among parous women, the odds for symptomatic pelvic organ prolapse increased with number of childbirths and were 3.3-fold higher among mothers of 4 than among mothers of 1. Indices of excessive stretching and tearing during labor (vaginal lacerations or episiotomies) were associated with increased risk for symptomatic pelvic organ prolapse. Instrumental delivery with forceps or vacuum did not seem to increase the risk of symptomatic pelvic organ prolapse, nor did length of delivery or maternal age at time for delivery. Abdominal deliveries appeared to be protective; the age- and parity-adjusted odds ratio of symptomatic pelvic organ prolapse after > or =1 abdominal deliveries was 0.5 (95% CI, 0.3-0.9), relative to women who had had only vaginal deliveries. A positive association with child birth weight in unadjusted analyses disappeared after adjustments for attained age and parity of the mother. CONCLUSION: Excessive stretching and tearing and multiple deliveries seem to be the main predisposing obstetric factors for symptomatic pelvic organ prolapse. Abdominal delivery emerged as a comparably strong protective factor.

Adult↗
PubMed2006

Cerebral hemodynamics in symptomatic and asymptomatic patients with severe unilateral carotid stenosis before and after carotid endarterectomy.

BACKGROUND: Data concerning hemodynamic status prior to and after carotid endarterectomy (CEA) in symptomatic and asymptomatic patients is insufficient. Transcranial Doppler (TCD) provides information regarding compensatory collateral flow as well as mechanisms of cerebral autoregulation in patients with carotid stenosis. PATIENTS AND METHODS: Forty eight symptomatic and 81 asymptomatic patients with unilateral severe carotid stenosis were examined by TCD before and in early postoperative period after CEA. RESULTS: Cigarette smoking was the only risk factor significantly more frequent in symptomatic patients. Preoperative anterior cerebral artery (ACA) and middle cerebral artery (MCA) asymmetry, basilar artery velocity and number of ophthalmic arteries with reversed flow, were not significantly different between the two groups. Pulsatility index, cerebrovascular reactivity and flow acceleration on the side of stenosis were significantly lower in symptomatic patients. After surgery there was a significant improvement of all TCD parameters in symptomatic as well as asymptomatic patients. CONCLUSIONS: The exhausted ability of cerebral autoregulation is an important factor differentiating between symptomatic and asymptomatic patients with severe carotid stenosis. Successful surgery provides good recovery of cerebral hemodynamics in both symptomatic and asymptomatic patients.

Aged↗
PubMed2005

B-mode ultrasonographic characterization of carotid atherosclerotic plaques in symptomatic and asymptomatic patients.

OBJECTIVE: To identify features on B-mode ultrasonography (US) prevalent in symptomatic plaques and correlate these findings with histopathologic markers of plaque instability. METHODS: Carotid endarterectomy (CEA) plaques from symptomatic and asymptomatic patients with critical stenoses (>70%) were qualitatively assessed using preoperative B-mode US for echolucency and calcific acoustic shadowing. US echolucency was quantitated ex vivo using computerized techniques for gray-scale median (GSM) analysis. Histopathologic correlates for US plaque echolucency (percentage of necrotic core area) and acoustic shadowing (percentage of calcification area) were determined. RESULTS: Fifty CEA plaques were collected from 48 patients (46 unilateral and two bilateral); 26 of these plaques were from symptomatic patients. Age, degree of stenosis, and atherosclerotic risk factors were similar for the symptomatic and asymptomatic patients. Using preoperative B-mode US, 58%, 35%, and 7% of symptomatic plaques and 18%, 41%, and 41% of asymptomatic plaques were found to be echolucent, echogenic, and calcific, respectively (P < .05). Using ex-vivo B-mode US and GSM analysis, symptomatic plaques were more echolucent (41 +/- 19) than asymptomatic plaques (60 +/- 13), P < .03. A strong inverse correlation was found between the percent plaque necrotic area core and GSM (R = -0.9, P < .001). Percentage of calcification area in plaques with acoustic shadowing was 66% and only 27% in those without acoustic shadowing (P < .05). CONCLUSIONS: Using B-mode US, symptomatic plaques are more echolucent and less calcified than asymptomatic plaques and are associated with a greater degree of histopathologic plaque necrosis. Such features are indicative of plaque instability and should be considered in the decision-making algorithm when selecting patients with high-grade asymptomatic carotid stenosis for intervention.

Algorithms↗
PubMed2005

Carotid atherosclerotic plaques from symptomatic stroke patients share the molecular fingerprints to develop in a neoplastic fashion: a microarray analysis study.

Identification of genetic mechanisms that promote the onset of stroke and transient cerebral ischemic attack symptoms in carotid atherosclerotic patients would further our understanding of the pathophysiology of this disease and could lead to new pharmacological and molecular therapies. Using Affymetrix Human Genome 230 GeneChip set, the present study evaluated the gene expression differences in geometrically similar carotid artery plaque samples extricated from six symptomatic stroke patients and four asymptomatic patients. There was no significant difference in the degree of stenosis between the two groups. Of the 44,860 transcripts analyzed, 289 (approximately 0.6% of the total transcripts) were differentially expressed between the plaques from the symptomatic and asymptomatic groups (236 were expressed more abundantly and 53 were expressed less abundantly in the symptomatic group). Of the 236 transcripts expressed more abundantly in the symptomatic plaques, 71% (167 transcripts) indicate an active cell proliferation and neoplastic process. These include oncogenes, growth factors, tumor promoters, tumor markers, angiogenesis promoters, transcription factors, RNA splicing factors, RNA processing proteins, signal transduction mediators and those that control the metabolism. Real-time polymerase chain reaction confirmed the increased expression of 63 transcripts in the symptomatic plaques. The other groups of transcripts expressed more abundantly in the symptomatic plaques are those that control ionic homeostasis, those that participate in the progression of degenerative neurological diseases (Alzheimer's disease, amyotrophic lateral sclerosis and Huntington's disease) and epilepsy. This indicates that symptomatic plaques are molecularly and biochemically more active than the asymptomatic plaques, or active plaque growth precipitates stroke symptoms.

Aged↗
PubMed1992

The relative proportion of stromal and epithelial hyperplasia is related to the development of symptomatic benign prostate hyperplasia.

The specific features of the prostate adenoma predisposing to the development of symptomatic benign prostatic hyperplasia (BPH) are unknown. Our objective was to determine whether the histological composition of the prostate adenoma is related to the development of symptomatic BPH. Prostate adenomas were obtained from men with asymptomatic BPH undergoing cystoprostatectomy for invasive transitional cell carcinoma, and from men with symptomatic BPH undergoing open prostatectomy, transurethral resection of the prostate and pharmacotherapy. The severity of bladder outlet obstruction was evaluated with the Boyarsky symptom score and uroflowmetry. The percentages of stroma, epithelium and glandular lumen were determined in the prostate adenomas via quantitative image analysis on a computer-assisted morphometry system. The prostate adenomas from the 33 men with symptomatic BPH contained 62 +/- 1%, 15 +/- 1% and 23 +/- 1 of stroma, epithelium and glandular lumen, respectively. The prostate adenomas from 6 men with asymptomatic disease contained 54 +/- 1%, 21 +/- 1% and 25 +/- 1% of stroma, epithelium and glandular lumen, respectively. The ratios of stromal-to-epithelial hyperplasia in the prostate adenomas from men with symptomatic and asymptomatic disease were 4.6 +/- 0.3 and 2.7 +/- 0.1, respectively. The differences in percentage of stroma and epithelium, and the stromal-to-epithelial ratio in the prostate adenomas from men with symptomatic and asymptomatic BPH were statistically significant. Our study suggests that the histological composition of the prostate adenoma is related to the development of symptomatic BPH.

Aged↗
PubMed2003

Human rotavirus strains bearing VP4 gene P[6] allele recovered from asymptomatic or symptomatic infections share similar, if not identical, VP4 neutralization specificities.

A rotavirus VP4 gene P[6] allele has been documented in a number of countries to be characteristically associated with an endemic predominantly asymptomatic infection in neonates in maternity hospital nurseries. The mechanisms underlying the endemicity and asymptomatic nature of such neonatal infections remain unknown. Rotavirus strains sharing this same P genotype, however, have more recently been recovered from an increasing number of symptomatic diarrheal episodes in infants and young children in various parts of the world. Previously, we have shown that an asymptomatic P[6] rotavirus neonatal infection is not associated with a unique VP7 (G) serotype but may occur in conjunction with various G types. Although amino acid sequence comparisons of the VP4 gene between selected "asymptomatic" and "symptomatic" P[6] rotavirus strains have been reported and yielded information concerning their VP4 genotypes, serotypic comparisons of the outer capsid spike protein VP4 of such viruses have not been studied systematically by two-way cross-neutralizations. We determined the VP4 neutralization specificities of four asymptomatic and four symptomatic P[6] strains: two each of asymptomatic and symptomatic strains by two-way tests, and two each of additional asymptomatic and symptomatic strains by one-way tests. Both asymptomatic and symptomatic P[6] strains were shown to bear similar, if not identical, VP4 neutralization specificities. Thus, P[6] rotavirus strains causing asymptomatic or symptomatic infections did not appear to belong to unique P (VP4) serotypes. In addition, a close VP4 serotypic relationship between human P[6] rotavirus strains and the porcine P[6] rotavirus Gottfried strain was confirmed.

Alleles↗
PubMed2000

Symptomatic and asymptomatic deep vein thrombosis after total hip replacement. Differences in phlebographic pattern, described by a scoring of the thrombotic burden.

The aim was to describe the phlebographic pattern of asymptomatic and symptomatic deep vein thrombosis (DVT) after total hip replacement by the use of a scoring system in 102 consecutive patients (54 asymptomatic, 48 symptomatic). The DVTs were scored from 1 to 3, and registered in a scoring system dividing the deep veins into 12 separate segments. The asymptomatic patients had a significantly lower total mean DVT score of 3.7 compared to 9.1 in the symptomatic group of patients. The mean ratio of the DVT scores in the deep muscle veins in conjunction with the superficial femoral vein in relation to the total mean score was significantly higher in the asymptomatic patients (74.9%) compared to the symptomatic group (62.4%). A direct sign of DVT, displayed as a filling defect, was seen on the phlebogram in 116 of the 119 legs, and concomitant nonfilling in other vein segments was noted in 6% of the asymptomatic patients, while in the symptomatic group this was the case to a significantly higher level, namely, 46%. A subgroup of asymptomatic patients operated unilaterally, with bilateral DVT had a significantly higher total mean DVT score on the operated side (4. 6) compared to the unoperated side (3.4). The total mean DVT score increased with time after surgery in the group of symptomatic patients. A low total mean DVT score with a predominance of DVT in, or in the connection to, the deep muscle veins is displayed among the asymptomatic patients. This is significantly different from the symptomatic patients who have more extensive DVTs, especially when diagnosed several weeks postoperatively, and frequently with edema and occlusive DVT.

Adult↗
PubMed2002

Assessment of cerebrovascular reserve capacity in asymptomatic and symptomatic hemodynamically significant carotid stenoses and occlusions.

BACKGROUND: Cerebrovascular reactivity measurements are believed to be a helpful tool for selecting patients who are at higher risk for hemodynamic strokes. The aim of this study was to compare cerebral vasoreactivity among patients suffering from internal carotid artery stenosis of different severity (asymptomatic stenosis, asymptomatic occlusion, symptomatic stenosis, symptomatic occlusion). METHODS: Sixty-two patients with asymptomatic and symptomatic internal carotid artery stenoses and occlusions underwent transcranial Doppler-acetazolamide tests. Absolute velocities of the middle cerebral arteries (MCAV), percent increases of the MCAV at different time points of the test (cerebrovascular reactivity, CVR) and maximal percent increase after administration of acetazolamide (cerebrovascular reserve, CRC) were compared on the affected and non-affected sides. Asymmetry indices (CRC (affected side)/CRC (non-affected side)) were compared between the groups of different severity of obstructive lesion. RESULTS: Resting MCAV was similar on both sides in all groups. A significant side-difference of the MCAV values after acetazolamide was observed only in the symptomatic groups. Difference of cerebrovascular reserve capacity between the affected and non-affected side was statistically significant only in the symptomatic groups (CRC symptomatic stenosis 36.6 +/- 20.9% vs. 71.1 +/- 27.9%, CRC symptomatic occlusion: 31.2 +/- 24.6% vs. 64.5 +/- 29.7%). Asymmetry index of the CRC was near to 1 in the asymptomatic stenosis group only, while in all the other groups this index referred to a significant hemispheric asymmetry of the vasoreactivity. CONCLUSIONS: Although in general cerebrovascular reserve capacity is compromised in cases of hemodynamically significant carotid lesions, there is a large individual variability within the subgroups. Further randomized studies are needed to clarify whether the clinical efficiency of carotid endarterectomy and extra-intracranial bypass may be improved by selecting the patients using hemodynamic criteria.

Acetazolamide↗
PubMed1995

Eosinophilic inflammation is associated with elevation of interleukin-5 in the airways of patients with spontaneous symptomatic asthma.

In vitro and in vivo studies have shown an important role for interleukin-5 (IL-5) in regulating eosinophil proliferation, survival, and effector function. Because eosinophilic inflammation is an important component of symptomatic episodes of asthma, we have investigated whether increased levels of IL-5 protein are present in bronchoalveolar lavage (BAL) fluid of patients with spontaneously symptomatic asthma (FEV1, l61% predicted; FEF25%-75%, 30% predicted) compared with patients with asymptomatic asthma (FEV1, 88% predicted; FEF25%-l75%, 76% predicted). The percent of BAL eosinophils (10.5% vs 0.6]) (p = 0.0001) and eosinophil-derived neurotoxin (386.0 ng/ml vs 6.3 ng/ml) (p = 0.0001) was greater in BAL fluids derived from patients with symptomatic asthma compared with patients with asymptomatic asthma. Levels of IL-5 measured with an immunoradiometric assay were significantly higher in patients with symptomatic asthma (n = 26) compared with those with asymptomatic asthma (n = 18) (274 pg/ml vs < pg/ml) (p = 0.02). The increased IL-5 levels were noted in a subset of patients with symptomatic asthma with BAL absolute eosinophil counts greater than 10(6) (IL-5, 664 pg/ml; n = 10) as opposed to patients with symptomatic asthma with BAL eosinophil counts less than 10(6) (IL-5, < 13 pg/ml; n = 16) (p = 0.005). This study suggests that IL-5 is not only induced in experimental models of allergen-induced asthma but can also be detected as asthma progresses from the asymptomatic to the clinically symptomatic state in subjects with significant BAL eosinophilia.

Adolescent↗
PubMed2002

Exercise-induced symptomatic ischaemia predicts a poor long-term prognosis after acute myocardial infarction.

STUDY OBJECTIVES: To evaluate the long-term prognostic significance of symptomatic ischaemia during exercise testing performed 3 weeks after acute myocardial infarction (AMI). DESIGN: A prospective study with long-term follow-up. SETTING: A Cardiac Rehabilitation Clinic in a University Hospital. SUBJECTS: A total of 446 patients were allowed to perform exercise testing 3 weeks after AMI and followed for 72 +/- 20 months. MEASUREMENTS AND RESULTS: Patients were divided into three groups according to whether they had no ECG evidence of ischaemia during exercise testing (334 patients), silent ischaemia (90 patients) or symptomatic ischaemia (22 patients). Cardiac death was significantly more frequent in patients with symptomatic ischaemia when compared with silent ischaemia (31.8% vs. 7.8%, P < 0.01) or when compared with no ischaemia (31.8% vs. 10.2%, P < 0.01). The three groups had a low cardiac mortality during the first 48 months of follow-up. The prognosis of patients with symptomatic ischaemia worsens markedly thereafter. The results of exercise testing did not predict recurrence of myocardial infarction. Coronary revascularization was performed in 34.4% of those without ischaemia, 47.8% of those with silent ischaemia and 45.5% of those with symptomatic ischaemia (P < 0.01). CONCLUSIONS: Patients with symptomatic ischaemia have a good prognosis during the first 4 years of follow-up. Their prognosis worsens thereafter as opposed to patients with or without silent ischaemia. This high-risk group of patients with symptomatic ischaemia deserves optimal management including revascularization when appropriate.

Analysis of Variance↗
PubMed1998

Allergen-induced synthesis of interleukin-5, but not of IgE, is a key mechanism linked to symptomatic episodes of seasonal allergic rhinitis in sensitized individuals.

Some individuals with detectable levels of Japanese cedar (Criptomeria japonica) pollen-specific immunoglobulin (Ig)E in serum have no apparent nasal symptoms during the pollen season. The response of CD4+ T-helper (Th) cells to the pollen allergen might differ fundamentally between asymptomatic and symptomatic individuals who are already sensitized to the pollen. The aim of this study was to discern the possible differences in responses of peripheral blood mononuclear cells (PBMCs) to the pollen allergen between asymptomatic and symptomatic subjects who have been sensitized to the pollen. This study included 20 non-atopic healthy volunteers (non-atopic group) and 48 patients who had detectable levels of the pollen-specific IgE before the pollen season in 1997. In the review of nasal symptoms during the pollen season 1997, 24 patients had typical symptoms of seasonal allergic rhinitis (symptomatic group), and the remainder had no seasonal aggravation of nasal symptoms (asymptomatic group). Peripheral blood mononuclear cells (1.0 x 10(7) cells/well) were obtained from each individual during the pollen season and cultured in the absence or presence of 12.5 microg of Cry j 1 for 4 days. The concentrations of IgE, interleukin-5 (IL-5), and interferon-gamma (IFN-gamma) in the culture supernatants were measured. The levels of IgE produced by Cry j 1-stimulated PBMCs of the asymptomatic and symptomatic groups were significantly higher than those of the non-atopic group, but did not differ between the asymptomatic and symptomatic groups. The levels of IL-5 produced by Cry j 1-stimulated PBMCs did not differ significantly between the non-atopic group and the asymptomatic group, but the levels of IL-5 were significantly higher in the symptomatic group than in the asymptomatic group as well as the non-atopic group. The levels of IFN-gamma produced by Cry j 1-stimulated PBMCs did not differ significantly among the three groups. In conclusion, our study has suggested that Japanese cedar pollen-induced synthesis of IL-5, but not of IgE or IFN-gamma, is likely to be a key mechanism linked to the symptomatic episode of seasonal allergic rhinitis in individuals sensitized to the pollen.

Adolescent↗
PubMed1990

Symptomatic and essential rhythmic palatal myoclonus.

Rhythmic palatal myoclonus (RPM) is a rare movement disorder consisting of continuous synchronous jerks of the soft palate, muscles innervated by other cranial nerves and, rarely, trunk and limb muscles. It usually develops secondary to brainstem or cerebellar disease (symptomatic RPM). Some patients, however, fail to show evidence of a structural lesion (essential RPM). A total of 287 cases with RPM from the literature including 210 cases with symptomatic and 77 cases with essential RPM have been reviewed and analysed statistically to look for criteria separating the two conditions. Patients with essential RPM usually have objective earclicks as their typical complaint which is rare in the symptomatic form. Eye and extremity muscles are never involved. The jerk frequency is lower in essential than in symptomatic RPM. Patients with essential RPM are younger and have a balanced sex distribution as compared with a male preponderance in the symptomatic form. The rhythmicity of RPM seems to be more profoundly influenced by sleep, coma and general anaesthesia in essential than in symptomatic RPM. We conclude from these results that essential RPM should be separated as a distinct clinical entity. Symptomatic RPM is a rhythmic movement disorder whose pathogenesis is quite well established. The cells of the hypertrophied inferior olives are believed to represent the oscillator. Among other possibilities, essential RPM may represent its functional analogue, based on transmitter changes only. Such a relationship could be of theoretical interest for the understanding of rhythmic hyperkinesias in general.

Age Factors↗
PubMed2001

Elevation of soluble intercellular adhesion molecule-1 levels in symptomatic and asymptomatic carotid atherosclerosis.

OBJECTIVE: Recent data suggest that the increased expression of intercellular adhesion molecule-1 (ICAM-1) in atherosclerotic plaque taken from the carotid bifurcation correlates with the development of neurological symptoms. As a result, the authors sought to compare the serum levels of soluble forms of ICAM-1 (sICAM-1) in patients who were asymptomatic with those who were symptomatic for carotid artery stenosis as well as in patients who were matched in terms of sex, age, and risk factors who did not have carotid artery disease. METHODS: Using enzyme-linked immunosorbent assay, serum sICAM-1 levels were prospectively determined in 54 patients scheduled to undergo carotid endarterectomy for either symptomatic or asymptomatic high-grade stenosis (> or =60%) and in 5 additional patient controls. Data are expressed as mean +/- standard error of the mean, with significance defined as P < 0.05 using the Mann-Whitney two-tailed test for two-column comparison or analysis of variance and Fisher protected least significant difference test. RESULTS: Using a univariate model, serum sICAM-1 levels were significantly elevated in patients with carotid artery stenosis as compared with control patients without stenosis (347 +/- 15 ng/ml versus 216 +/- 8.2 ng/ml) (P < 0.01). When the asymptomatic and symptomatic patients with carotid artery stenosis were considered separately, these levels were still elevated relative to those of control patients (asymptomatic [312 +/- 18 ng/ml] and symptomatic [376 +/- 22 ng/ml] patients; P = 0.06 for asymptomatic versus control patients, P < 0.01 for symptomatic versus control patients). Symptomatic patients also had significantly elevated sICAM-1 levels as compared with asymptomatic patients (P < 0.05). Despite the fact that female patients demonstrated higher ICAM-1 levels than male patients (P < 0.05), sex, age, and risk factors such as the presence of hypercholesterolemia, diabetes, hypertension, or a history of smoking did not confound these findings. CONCLUSION: Levels of sICAM-1 are higher in patients with carotid stenosis than in control patients. Symptomatic patients demonstrate significantly elevated levels as compared with asymptomatic patients. These data support the contention that ICAM-1 is a reliable marker of carotid disease progression and suggest that serum levels may be useful in following certain asymptomatic patients.

Aged↗
PubMed2000

Comparison of symptomatic and asymptomatic, chronic, primary angle-closure glaucoma, open-angle glaucoma, and controls.

PURPOSE: To determine the clinical features and anatomic parameters in asymptomatic (creeping) and symptomatic, chronic, primary angle-closure glaucoma (PACG) as compared with open-angle glaucoma (OAG) and with control subjects with normal eyes. METHODS: Forty consecutive patients with each of the following four types of eyes were studied (N = 160): eyes with symptomatic PACG, eyes with asymptomatic PACG, eyes with OAG, and the eyes of age-, sex-, and refraction-matched control subjects. The refractive status, keratometry, pachymetry, corneal diameter, anterior chamber depth, lens thickness, axial length, and relative lens position were noted. The groups were compared using a paired t test and analysis of variance. RESULTS: Patients with asymptomatic chronic PACG were older than patients in the symptomatic group, were more often men, and were more likely to have either diabetes mellitus or hypertension. Symptomatic chronic PACG eyes were more hypermetropic. Asymptomatic eyes had more iridotrabecular synechiae and minimal pupillary ruff atrophy as compared with the symptomatic eyes that had largely iridocorneal synechiae and large areas where the ruff was absent. All other clinical and anatomic parameters were statistically similar in the two groups, but differed significantly from OAG and control eyes. CONCLUSIONS: The ocular parameters of asymptomatic or creeping angle closure eyes show that these are significantly different from eyes having POAG. Asymptomatic and symptomatic chronic PACG eyes are structurally similar. Open-angle glaucoma eyes and normal eyes were comparable, but differed from both the chronic angle-closure glaucoma groups in having a larger corneal diameter, deeper anterior chamber, thinner lens, and a longer axial length. The symptomatic chronic PACG eyes showed more evidence of ischemic damage to the iris, and this could account for the symptoms reported by these patients.

Aged↗
PubMed2006

Mesalazine and/or Lactobacillus casei in preventing recurrence of symptomatic uncomplicated diverticular disease of the colon: a prospective, randomized, open-label study.

GOALS: To investigate the effectiveness and safety of mesalazine, with or without Lactobacillus casei, in preventing recurrence of symptomatic diverticular disease of the colon. BACKGROUND: Both mesalazine and probiotics showed recently their effectiveness in obtaining remission of symptomatic uncomplicated diverticular disease of the colon. Consistent data are not available on the optimal therapy to prevent recurrence of symptomatic diverticular disease of the colon. STUDY: Multicenter, prospective, randomized, open-label study. Ninety consecutive patients (36 men, 54 women, mean age 67.5 y, range 39 to 84 y), previously affected by symptomatic uncomplicated diverticular disease of the colon (remission obtained with rifaximin 800 mg/d plus mesalazine 2.4 g/d for 10 d, followed by mesalazine 1.6 g/d for 8 wk), were enrolled in a 12-month follow-up. The following symptoms were assessed at entry and through follow-up by using a quantitative scale: (1) constipation, (2) diarrhea, (3) abdominal pain, (4) rectal bleeding, and (5) mucus with the stools. After recruitment, the patients were randomly assigned to one of the following 3 groups: mesalazine 1.6 g/d (group M), L. casei DG 16 billion/d for 15 d/mo (group L); mesalazine 1.6 g/d+L. casei DG 16 billion/d for 15 d/mo (group LM). RESULTS: Eighty-five patients completed the study (94.5%): 2 patients (2.22%, 1 of group M and 1 of group LM) were withdrawn from the study for protocol violation and 1 (1.11%) for hospital admission due to acute pulmonary disease (group L); 2 patients (2.22%) were lost to follow-up. Seventy-five patients (88.2%) were symptom free after the 12th month of treatment (overall symptomatic score: (0): 23/27 patients of group M [on intention to treat: 76.7% confidence interval (CI 95%: 61.5 to 91.8)], 23/29 of group L [on intention to treat: 76.7% (CI 95%: 61.5 to 91.8)], 29/29 of group LM [on intention to treat: 96% (CI 95%: 94.2 to 100)] (P < 0.05). Only 10 patients (11.1%) showed recurrence of symptoms (overall symptomatic score: 68). CONCLUSIONS: Both mesalazine and L. casei DG seem to be effective in preventing recurrence of symptomatic uncomplicated diverticular disease of the colon, but their association seems to be more promising in this field.

Adult↗
PubMed2004

Asymptomatic parasitaemia as a risk factor for symptomatic malaria in a cohort of Ugandan children.

OBJECTIVES: To assess the prevalence of asymptomatic parasitaemia, determine its association with symptomatic malaria, and identify independent predictors of asymptomatic parasitaemia in a cohort of children from Kampala, Uganda. METHODS: A total of 316 children aged 6 months to 5 years were recruited from the community. The prevalence of asymptomatic parasitaemia was assessed at enrollment and approximately every 30 days during follow-up. Participants received all of their health care in our clinic, including a standardized approach to the diagnosis and treatment of symptomatic malaria. RESULTS: A total of 283 (90%) subjects completed the full 1-year follow-up and were included in this study, yielding 2557 routine smears. The prevalence of asymptomatic parasitaemia was 17% at enrollment, but 5-8% for the remainder of the study. The risk of developing symptomatic malaria within 30 days was significantly higher in those with a positive routine than in those with a negative one (50%vs. 9%, P < 0.001). Higher parasite densities were associated with increased odds of developing symptomatic malaria within 30 days (P = 0.003). Only 11% of episodes of asymptomatic parasitaemia, involving 6% of subjects, arose and cleared without therapy. In multivariate analysis the only significant risk factor for asymptomatic parasitaemia was whether a child had any episode of symptomatic malaria during the course of the study (OR = 3.0, P = 0.02). CONCLUSION: In our cohort of children from an urban meso-endemic environment, asymptomatic parasitaemia was uncommon and frequently followed by symptomatic malaria. This suggests that presumptive treatment of asymptomatic parasitaemia in such settings would be an efficient means of preventing symptomatic malaria.

Child, Preschool↗