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At least 1,243 records · Page 69Linked to original sources
PubMed2002

Adult testicular torsion.

PURPOSE: Testicular torsion in adulthood is thought to be relatively unusual. We compared a series of men 21 years old or older with testicular torsion with a concurrent series of younger patients with torsion. MATERIALS AND METHODS: We reviewed the medical records of patients admitted with testicular torsion in a 9-year period to hospitals affiliated with our institution. Data included patient demographics, history, physical findings, radiographic results if any, operative findings and outcome (testicular salvage versus loss). RESULTS: The charts of 48 patients were evaluated. Excluded from study was a neonate with torsion and 3 males who underwent delayed surgery for presumed missed torsion. Of the remaining 44 patients we compared 17 who were 21 years old or older (range 21 to 34) with 27 younger than 21 (range 8 to 20). The salvage rate differed in the 2 age groups with 70.3% of testes salvaged in the younger group versus only 41% in the older group. A factor affecting salvage in each group was time to presentation. In the older age group patients in whom the testis was lost had a significantly higher mean delay in presentation than those in whom it was salvaged (102 versus 11 hours). A similar pattern was noted in the younger group with a mean time to presentation of 108 and 6.5 hours in those with testicular loss and salvage, respectively. Mean time between presentation and operation was 7.1 hours in the older and 4.8 in the younger group, which was not statistically different. A significant difference was noted in the degree of spermatic cord twisting. The cord was twisted a mean of 585 degrees in the adults versus 431 in the younger group. CONCLUSIONS: Testicular torsion in adults was more common in our series than expected. Salvage of the affected testis was better in younger patients, presumably due to less twisting of the cord.

Adolescent↗
PubMed1997

[A case report of Listeria monocytogenes infection in a patient with AIDS. Efficacy of treatment with cotrimoxazole associated with rHuG-CSF (filgrastim)].

Listeriosis is an emerging opportunistic infection in the immunocompromised host. A case of sepsis due to Listeria monocytogenes in a patient with advanced HIV infection and severe neutropenia, treated for an underlying non-Hodgkin's lymphoma, is described. Therapy with cotrimoxazole associated with rHuG-CSF (filgrastim) led to a rapidly favourable clinical and microbiological outcome, and to the correction of concurrent neutropenia. The case report is discussed according to a literature review of all cases of listeriosis reported until now in the setting of HIV infection and AIDS. In particular, the role of both cotrimoxazole and rHuG-CSF adjunct in the treatment of listeriosis in the immunocompromised patient is focused.

English Abstract↗
PubMed1992

Second primary malignancies associated with primary female breast cancer: a review of the Danbury Hospital experience.

Second primary tumors associated with breast cancer are well known. The purpose of this retrospective study is to review the Danbury Hospital experience with second primary tumors following or concurrent with a diagnosis of breast cancer. Eighty-three women with an initial diagnosis of breast cancer between 1970 and 1986 developed second primary malignancies, most commonly in the contralateral breast, followed by colon or rectum. The median time to second diagnosis was shorter for the colorectal group than for the other sites. The occurrence of a second primary malignancy in general seemed to be more likely in the postmenopausal group, and the presence of a family history of breast cancer in a first degree relative was more often associated with second primary malignancy located in the contralateral breast. Patients who had had systemic therapy showed a shorter mean interval to second diagnosis than those who had received local therapy alone among the subset of patients with a second malignancy in the contralateral breast. Additionally, there was no tendency to discover the second primary breast cancer at an earlier stage than the first. These results suggest the importance of bowel surveillance once a diagnosis of breast cancer is made. They also suggest the importance of contralateral breast surveillance, especially with a positive family history, and that current methods of surveillance need to be reevaluated.

Breast Neoplasms↗
PubMedDate not supplied

Intrathecal therapy in tetanus. A meta-analysis.

OBJECTIVE: --To assess the efficacy of intrathecal therapy with tetanus antibody (antitetanus equine serum or human tetanus immune globulin) in neonatal and adult tetanus using meta-analytical techniques. DATA SOURCES: --Clinical trials identified by searching MEDLINE and by reviewing bibliographies of published articles. STUDY SELECTION: --Studies in English with concurrent controls treated without intrathecal therapy. DATA EXTRACTION: --Data were extracted by one author and verified by the second; conflicts were resolved by discussion. DATA SYNTHESIS: --No major treatment effect was found in neonatal tetanus when all studies were considered. A benefit was suggested for antitetanus equine serum in adult disease, but this finding should be accepted with caution. Subgroup analyses were limited in power. Methodological difficulties in neonatal and adult trials were common and safety has not been established. CONCLUSIONS: --Intrathecal therapy for tetanus with either antitetanus equine serum or human tetanus immune globulin is not of proven benefit and should only be given in the context of well-designed, controlled trials.

Adult↗
PubMed1991

The role of cisplatin in treatment regimens for squamous cell carcinoma of the head and neck.

Advanced squamous cell carcinoma of the head and neck (SCCHN) is both a local-regional and a systemic disease that is ineffectively managed by conventional surgery and radiotherapy. For patients with advanced but potentially curable (Mo) disease, the morbidity associated with conventional surgery or radiotherapy may be significant whereas the probability of lasting disease control is low. For those with recurrent or metastatic lesions, surgery or radiotherapy are rarely effective options. In this setting, chemotherapy has been evaluated as primary therapy for patients with recurrent or metastatic disease and as an adjunct to surgery or radiotherapy for those with potentially curable lesions. As palliative therapy, methotrexate remains the single agent of choice. Combination chemotherapy has been associated with a higher response rate but not improved survival when compared with methotrexate alone. Cisplatin, both as a single agent and in combination with 5-fluorouracil, is active against SCCHN, and may be superior to methotrexate in antitumor activity. The impact of induction and adjuvant chemotherapy or concurrent chemotherapy and radiotherapy in patients with potentially curable lesions remains controversial. A specific role for chemotherapy has not been confirmed by prospective randomized trial, but effective therapies have been achieved: Regimens with increased activity against squamous carcinomas have been reported, clinical trials with sufficient power to reach significant conclusions have been published, and organ preservation has been confirmed as an appropriate end point for studies of induction chemotherapy or concurrent chemotherapy and radiation. The clinical experience with chemotherapy for patients with recurrent or metastatic SCCHN as well as induction and adjuvant chemotherapy and concurrent chemotherapy and radiotherapy for those with potentially curable disease is reviewed, with particular emphasis given to trials involving cisplatin and to avenues for continued clinical investigation.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1989

System for voluntary reporting of adverse drug reactions in a university hospital.

The development and implementation of a system to improve voluntary reporting of adverse drug reactions (ADRs) is described. A preliminary study comparing three concurrent voluntary reporting systems at a 327-bed university teaching hospital demonstrated the ability of medical records personnel to identify ADRs that were documented in the medical record but not reported under the voluntary system. It was concluded that a concurrent voluntary reporting system would be coupled with a medical record review process that would focus reporting on clinically important and unexpected ADRs. Failures to report ADRs would be handled through existing procedures of staff privilege allocation and peer review. The baseline ADR rate was determined. A telephone reporting system was established for the medical staff. After review of reported reactions by pharmacy, feedback was provided to ADR reporters and the medical staff. During the first three months under the new system, 9 of 114 documented ADRs were reported, compared with none in the three months before the program began. All ADRs defined as reportable were reported. An ADR-reporting system designed to encourage voluntary reporting of selected reactions, monitor the baseline rate of ADR occurrence, and assess compliance with reporting criteria appears to operate satisfactorily.

Drug-Related Side Effects and Adverse Reactions↗
PubMed1987

Simultaneous colpo-recto-sacropexy.

The literature concerning coexisting massive genital and intussuscepting rectal prolapse is reviewed, two cases in point are presented, and the rationale for concurrent surgical management is offered. The technique of combined colporecto-sacropexy is described in detail.

Aged↗
PubMed1996

Is stage pT4a (D1) reliable in assessing transitional cell carcinoma involvement of the prostate in patients with a concurrent bladder cancer? A necessary distinction for contiguous or noncontiguous involvement.

PURPOSE: A series of patients with concurrent transitional cell carcinoma involvement of the prostate and bladder is reviewed to define the impact of prostate involvement pathways and the degree of prostate invasion on survival rate. MATERIALS AND METHODS: A total of 72 patients who underwent radical cystectomy for pathological stage pT4a (D1) cancer was divided into contiguous--stage pT4a, transitional cell carcinoma of the bladder extended into the prostate through the bladder wall and noncontiguous--stage pT4a simultaneous transitional cell carcinoma of the prostate and bladder carcinoma that did not directly infiltrate into the prostate through the bladder wall. In the latter group the degree of prostate invasion was classified as urethral mucosal involvement, ductal/acinar involvement, stromal invasion and extracapsular extension. The survival rate was estimated by the Kaplan-Meier and Cox proportional hazards methods. Comparisons between curves were performed by univariate log rank and multivariate L-ratio tests. RESULTS: The overall 5-year survival rate for stage pT4a was 21.5% (median followup 64 months). Furthermore, 46% and 7% of patients in noncontiguous and contiguous pT4a groups, respectively, were estimated to be alive (p < 0.000). Those with positive nodes experienced a poor outcome in both groups. Of patients with noncontiguous pT4a stage 100% with urethral mucosal involvement, 50% with ductal/acinar involvement and 40% with stromal invasion were estimated to be alive. The major prognostic factors were bladder tumor stage, nodal involvement and degree of prostate invasion. CONCLUSIONS: The invasion pathways of the prostate in patients with transitional cell bladder carcinoma have a statistically significant prognostic role. Contiguous and noncontiguous involvements are 2 distinct clinicopathological features and they should not be included in the same stage. In the noncontiguous stage pT4a group bladder and prostate transitional cell carcinoma should be separately staged, and prostate involvement also should be staged according to invasion degree.

Carcinoma, Transitional Cell↗
PubMed1995

Legal liability under managed care.

Market forces are driving the delivery of health care into managed care. New alignments among health care providers, payers, utilization reviewers and hospitals create new legal liability. Better-informed patients, concurrent credentialing by hospitals and payers, and new incentives to reduce hospital and physician-related costs have resulted in new federal legislation and agencies that reshape health care delivery and legal liability.

Hawaii↗
PubMedDate not supplied

[Neural manifestations in Lyme disease (Lyme borreliosis of the nervous system)].

The involvement of the nervous system is common during Lyme's disease, and the term neuroborreliosis has been established. All structures of the nervous system, from meninges to periferial nerves, can be involved. Neurological manifestations are most common in the second stage (dissemination). The article deals with the most important neurological manifestations, as well as with the contemporary pathogenetic considerations and therapy. Eleven patients with neuroborreliosis who were treated at Dr. Kosta Todorovitsh Institute of Infectious and Tropical Diseases, are reviewed. Five of them had acute meningoencephalitis, of whom two had concurrent neuritis; one patient had Banawart's syndrome with arthralgias, arthritis and fatigue syndrome; two patients had neuritis; one had bilateral facial palsy; two had chronic fatigue syndrome.

Adult↗
PubMed1998

The association of intra-abdominal infection and abdominal wound dehiscence.

Concurrent infection is a risk factor for abdominal wound dehiscence. We reviewed our experience with fascial dehiscence to determine the incidence and to identify prognostic factors for associated intra-abdominal infection. Over a 7-year period, 107 patients with abdominal wound dehiscence were identified. Seventeen were managed nonoperatively, and 90 underwent exploratory laparotomy, 43 of whom had no intra-abdominal pathology and 47 of whom had intra-abdominal infections. Demographic factors, comorbid diseases, and potential indicators of systemic infection did not distinguish patients with intra-abdominal infection from those without. Patients with an intra-abdominal infection were more likely to have undergone an emergency operation (74% vs 48%; P < 0.02), an operation on the colon (55% vs 25%; P < 0.005), or an operation with a higher wound classification (P < 0.02). Mortality was higher in patients with intra-abdominal infection than in those without (44% vs 20%; P < 0.02). Wound dehiscence after emergent operations, and operations with a higher wound classification, especially those involving the colon, should raise concern for intra-abdominal infection. Thorough abdominal exploration should be performed at the time of dehiscence repair. Before nonoperative management is chosen, intra-abdominal infection should be excluded.

Abdominal Abscess↗
PubMed2003

Saquinavir: a review of its use in boosted regimens for treating HIV infection.

UNLABELLED: Protease inhibitor boosting involves concurrent administration of a protease inhibitor, such as saquinavir, plus a potent inhibitor of cytochrome P450 (CYP) 3A4, usually ritonavir in subtherapeutic doses. Since protease inhibitors are extensively metabolised by CYP3A4, this results in a marked increase in systemic exposure of saquinavir or other protease inhibitors boosted by ritonavir. As with traditional protease inhibitor regimens, boosted regimens are typically used in combination with nucleoside reverse transcriptase inhibitors (NRTIs). In protease inhibitor-experienced and -naive patients with HIV infection, twice-daily and once-daily boosted saquinavir regimens achieved good rates of viral suppression, improved CD4+ cell counts and were generally well tolerated in clinical trials. Encouraging results have also been reported in a number of small studies in heavily pretreated HIV-infected patients who received salvage therapy comprising double-boosted regimens of saquinavir plus lopinavir with subtherapeutic doses of ritonavir, along with other agents. The largest clinical trials have been multicentre, randomised comparisons of twice-daily boosted saquinavir versus twice-daily boosted indinavir (MaxCmin1) or lopinavir (MaxCmin2) regimens. In the MaxCmin1 study, >90% of patients in both groups had an undetectable viral load (<400 copies/mL) after 48 weeks of therapy in the on-treatment analysis. However, viral suppression was achieved in significantly more saquinavir than indinavir recipients in the intention-to-treat analysis, which appeared to be due to the significantly greater percentage of patients in the indinavir group who switched from randomised therapy because of adverse events. Interim 24-week results of the MaxCmin2 trial indicate that 90% of patients in both groups combined had plasma HIV RNA levels <400 copies/mL; final results at 48 weeks will report data separately for the boosted regimens of saquinavir and lopinavir. CONCLUSION: Boosted protease inhibitor regimens (including two NRTIs) are recommended as a first-line option in current HIV treatment guidelines and are used extensively in clinical practice. The convenient administration schedule and good pharmacokinetic profile associated with boosted saquinavir regimens have the potential to increase adherence to therapy and improve antiretroviral effects through increased drug exposure. Twice-daily boosted saquinavir is one of the most extensively evaluated boosted protease inhibitor regimens and has been shown to have good efficacy on surrogate markers of HIV disease as well as significant tolerability advantages over boosted indinavir. Once-daily boosted saquinavir regimens may be most suitable for HIV-infected patients with busy lifestyles and those who would benefit from directly observed therapy.

Area Under Curve↗
PubMed1995

Hirschsprung's disease associated with Ondine's curse: a special subgroup?

The authors report a case of the rare occurrence of congenital central hypoventilation syndrome (Ondine's curse) and long segmental colonic aganglionosis (Hirschsprung's disease). A review of 24 reported cases showed that the proportion of females having this concurrence is higher than for ordinary Hirschsprung's disease. It also appears that the aganglionic segment is much longer in these cases than in ordinary Hirschsprung's disease.

Female↗
PubMed1998

Cryptococcosis in Hodgkin's disease: description of two cases and review of the literature.

Systemic mycosis caused by Cryptococcus neoformans frequently becomes life threatening in patients with cellular immunodeficiencies. In contrast to AIDS patients, there are only a few reports of concurrent systemic cryptococcosis in patients with Hodgkin's disease (HD). Only two of 75 (2.7%) patients with HD who were consecutively admitted to our hospital in the past decade developed Cryptococcus neoformans infection. Both had stage IVB (Ann Arbor) HD with bone marrow involvement and absolute lymphopenia (< 1/nl). We have reviewed the literature and analyzed the data of 54 cases with concurrent cryptococcosis and HD. Presence of HD for > or = 12 months, stage IV disease, absolute lymphopenia (< 1/nl), and extensive pretreatment were the most common features among these patients and must be regarded as predisposing for acquiring a cryptococcal infection. In our patients antimycotic therapy was successful using liposomal amphotericin B (lipAmB) simultaneously with cytotoxic therapy for HD. Drug level measurements performed in one patient revealed a higher level of amphotericin B in CSF when the liposomal formulation was administered as compared with the level in CSF after administration of conventional amphotericin B. To our knowledge, this is the first report on antimycotic treatment of cryptococcosis with lipAmB in patients with HD. Regarding the favorable therapeutic index of lipAmB as compared with conventional amphotericin B, the drug should be considered as a less toxic and perhaps more effective alternative in the therapy of acute cryptococcosis, especially when cytotoxic treatment is administered simultaneously.

Adult↗
PubMed1991

[HIV infection and syphilis. Case description and literature review].

Recent case reports emphasize that HIV infection may influence the clinical picture, course and therapy of concurrent syphilis. The case of a 32-year-old patient with coinfection by T. pallidum and HIV is presented. Clinical presentation, diagnostic procedures and therapy are discussed in the light of the current literature. False negative serologic tests for syphilis in HIV-patients raise the question of the sensitivity of these tests in HIV infection. Efficacy of therapy for neurosyphilis and the value of CSF (cerebrospinal fluid) examination in early syphilis are of increased importance in HIV infection. Current guidelines for diagnosis and therapy of syphilis in HIV patients are outlined.

AIDS Serodiagnosis↗
PubMed2005

Cytomegalovirus-induced thrombocytopenia in an immunocompetent adult effectively treated with intravenous immunoglobulin: a case report and review.

The authors report the case of an 80-year-old male patient who presented with colitis and severe thrombocytopenia. The work-up revealed concurrent cytomegalovirus infection. After failure of prednisone, a single infusion of high-dose intravenous immunoglobulin produced a rapid and sustained response. Seventeen cases from the world literature are reviewed. Corticosteroids seem effective in about one third of cases. In those who do not respond, splenectomy is relatively ineffective and more specific anti-CMV treatment with ganciclovir is of unproven efficacy and toxic, in view of the relatively favourable long term outcome the authors recommend intravenous immunoglobulin in cases of severe bleeding or when the platelet level is under 10 x 10(9) l.

Aged, 80 and over↗
PubMed2001

Pre- and perinatal findings in partial trisomy 7q resulting from balanced parental translocations t(7;21) and t(4;7).

We report on a fetus and a newborn, both with partial trisomy 7q21-->qter due to different familial translocations, t(7;21)(q21.2;p12) and t(4;7)(q35;q21.2). Postmortem examination of the 19-week-old female fetus disclosed dysmorphic features, cleft palate, anomalies of the great vessels, intestinal malrotation and uterus bicornis. The newborn girl revealed a pattern of minor anomalies, cleft palate, cerebellar hypoplasia, and anomalies of pancreas, gall bladder and appendix. The clinical findings in three other reported fetuses with partial trisomy 7q described so far are reviewed. A duplication 7q21-->qter, as found in the propositi, has only been described in 11 patients who all had a concurrent partial monosomy. Patient 1 is particularly interesting since she is, to our knowledge, the first reported case with pure trisomy 7q21/22-->qter. We reviewed the phenotype of the previously described patients, compared it with the propositae, and summarized the clinical features of pure trisomy 7q21/22-->qter.

Adolescent↗
PubMedDate not supplied

Coexistence of Crohn's disease and inflammatory fibroid polyp of the small bowel. Report of a case and review of the literature.

BACKGROUND/AIM: The Authors report a case of a woman aged 35, with concurrent appearance of Crohns disease and Inflammatory Fibroid Polyp of the terminal ileum. CASE REPORT: The combination of the two disorders was clinically manifested as an obstructive ileus. On the operative table, a 4-cm polypoid mass causing intussusception of the bowel was obvious. The resected specimen of the ileum showed profound distention, several ulcerations and fissures. The histological examination confirmed the diagnosis of Crohn's disease coexisting with an Inflammatory Fibroid Polyp. Immunostaining of the lesion for actin showed focal positivity. However, staining for desmin, CD31, S100-protein, PGM-1 CD34, CD117, and bc1-2, was negative. CONCLUSION: Coexistence of Inflammatory Fibroid Polyp with Crohn's disease causing obstructive ileus could be the first manifestation of the disease. The combination of the two disorders corroborates the reparative character of the lesion. Nevertheless, the exact etiopathogenetic relationship between the two entities remains obscure.

Abdomen, Acute↗