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PubMed2006

Molecular analysis of bacteria in asymptomatic and symptomatic endodontic infections.

The purpose of the present study was to use terminal restriction fragment length polymorphism analysis and the 16S rRNA gene clone library to investigate the diversity of the microbiota associated with asymptomatic and symptomatic endodontic infections and to compare the bacterial community structure in these two clinical conditions. Samples were taken from asymptomatic endodontic infections associated with chronic periradicular lesions and from symptomatic infections clinically diagnosed as acute abscesses. 16S rRNA genes from DNA isolated from clinical samples were used to construct clone libraries or were subjected to terminal restriction fragment length polymorphism analysis. Sequence analysis of 186 clones revealed 42 taxa; 23 (55%) were uncultivated phylotypes, of which seven were unique to endodontic infections. Clone sequencing and terminal restriction fragment length polymorphism analysis revealed that the most commonly detected taxa were Fusobacterium nucleatum (including terminal restriction fragment types 1 and 2), Peptostreptococcus micros/Peptostreptococcus sp. oral clone AJ062/BS044/FG014, Prevotella species, Dialister species, Mogibacterium species, Lachnospiraceae oral clone 55A-34, Filifactor alocis, Megasphaera sp. oral clone CS025/BS073, and Veillonella sp. oral clone BP1-85/Veillonella dispar/V. parvula. Bacteroides-like sp. oral clone X083/Bacteroidales oral clone MCE7_20 and Dialister sp. oral clone BS016/MCE7_134 were detected only in asymptomatic teeth. On the other hand, F. nucleatum terminal restriction fragment type 2, Prevotella intermedia, Dialister pneumosintes, and some phylotypes were exclusively detected in symptomatic samples. Bacterial profiles of symptomatic endodontic infections generated by terminal restriction fragment length polymorphism analysis were clearly different from those of asymptomatic infections. Overall, the average number of terminal restriction fragments in symptomatic samples was significantly larger than in asymptomatic samples. Molecular analysis of the microbiota associated with symptomatic or asymptomatic endodontic infections indicates that the endodontic bacterial diversity is greater than previously described by culture methods and that the structure of the microbiota differ significantly between asymptomatic and symptomatic infections.

Adolescent↗
PubMed1998

Acute symptomatic seizure disorders in young children--a population study in southern Taiwan.

PURPOSE: To determine the incidence, etiology, and prognosis of acute symptomatic seizures in children by age 3 years. METHODS: In a population-based birth cohort study of all 15,209 neonatal survivors born in Tainan City between October 1989 and December 1991, parents or caretakers of 13,493 children aged 3 years were surveyed by telephone regarding any provoked convulsive disorder, particularly acute symptomatic seizure, in the children; medical records were reviewed. RESULTS: Sixty-three children (39 boys, 24 girls) had acute symptomatic seizures (incidence 0.46 in 100). The leading causes of acute symptomatic seizures were acute gastroenteritis, encephalitis/encephalopathy, and bacterial meningitis. Age-specific incidence was highest in the group aged 1-12 months. Intracranial hemorrhage, bacterial meningitis, and metabolic disturbance were the major causes of acute symptomatic seizures in children aged 1-12 months. Acute gastroenteritis, encephalitis/encephalopathy, and bacterial meningitis accounted for 85% of the causes in children aged 13-24 months, and gastroenteritis and encephalitis/encephalopathy were the predominant causes in those aged 25-36 months. By age 5 years, subsequent unprovoked seizures developed in 14% of the survivors of acute symptomatic seizures. CONCLUSIONS: Many acute symptomatic seizures are preventable. The risk of subsequent unprovoked seizures is determined by underlying precipitating factors. Public education regarding the danger of shaken-baby syndrome and excessive water supplement, as well as and nationwide vaccination against bacterial meningitis in young children, is necessary.

Acute Disease↗
PubMed2005

Mortality in the first 30 days following incident acute symptomatic seizures.

PURPOSE: Very little is known about short-term mortality after acute symptomatic seizure. One study found an increased mortality in the first year after acute symptomatic seizure, like mortality following acute symptomatic status epilepticus. METHODS: We studied mortality in the first 30 days after an acute symptomatic seizure in two cohorts. In Washington Heights, New York City, we reviewed the medical records of all adults aged 20 years and older seen at Columbia Presbyterian Medical Center from January 1, 1990 through December 13, 1994 to identify incident acute symptomatic seizure. In Rochester, Minnesota, the medical records of all Rochester residents were reviewed to identify incident acute symptomatic seizure from January 1, 1965 through December 31, 1984. Case fatality (CF) and standardized mortality ratio (SMR) were calculated for deaths in the first 30 days. RESULTS: A total of 323 adults were identified in Washington Heights and 428 in Rochester. The CF was 20% in both cohorts. CF was greatly increased in the people aged 65 years and older (28.4% in Washington Heights and 40.5% in Rochester) versus younger individuals (17.7% in Washington Heights and 11.2% in Rochester). In both cohorts, the SMR was greatly increased overall (102.1 in Washington Heights and 149.4 in Rochester), and separately for males, females, all etiologies except head trauma in Washington Heights, and younger individuals. In older individuals, the SMR was increased in Washington Heights but not in Rochester. CONCLUSION: Acute symptomatic seizures are associated with increased mortality in the first 30 days. It is unknown how seizures contribute to this mortality or whether mortality is due solely to the underlying medical condition.

Acute Disease↗
PubMed2001

Association of bowel movement frequency and use of laxatives with the occurrence of symptomatic gallstone disease in a prospective study of women.

OBJECTIVES: The authors prospectively examined the association between bowel movement frequency (used as a proxy for intestinal transit), laxative use, and the risk of symptomatic gallstone disease. METHODS: A total of 79,829 women, aged 36-61 yr, without a history of symptomatic gallstone disease and free of cancer, responded to a mailed questionnaire in 1982 that assessed bowel movement frequency and use of laxatives. Between 1984 and 1996, 4,443 incident cases of symptomatic gallstone disease were documented. Relative risks (RRs) of symptomatic gallstone disease and 95% confidence intervals (CIs) were calculated using logistic regression. RESULTS: After controlling for age and established risk factors, the multivariate RRs were, compared to women with daily bowel movements, 0.97 (95% CI 0.86-1.08) for women with bowel movements every third day or less, and 1.00 (95% CI 0.91-11.1) for women with bowel movement more than once daily. No trend was evident. As compared to women who never used laxatives in 1982, a significant modest inverse association was seen for monthly laxative use, with a multivariate RR of 0.84 (95% CI 0.72-0.98), and weekly to daily laxative use was associated with a RR of 0.88 (95% CI 0.78-1.02). CONCLUSIONS: These findings do not support an association between infrequent bowel movements and risk of symptomatic gallstone disease in women, and indicate that simple questions directed at bowel movement frequency are unlikely to enhance our ability to predict risk of symptomatic gallstone disease. The slightly inverse association between use of laxatives and risk of symptomatic gallstone disease may be due to a mechanism that is not related to bowel movement frequency.

Cathartics↗
PubMed1991

Symptomatic gastro-oesophageal reflux, abnormal oesophageal acid exposure, and mucosal acid sensitivity are three separate, though related, aspects of gastro-oesophageal reflux disease.

The Bernstein test has been used as a test of oesophageal acid sensitivity for over 30 years but its clinical value has been challenged by the advent of ambulatory pH monitoring. Furthermore, the relation between mucosal acid sensitivity, symptomatic reflux, and abnormal oesophageal acid exposure time is unclear. This study examined the relation between these three parameters in patients referred for pH monitoring with unexplained chest pain or heartburn. Fifty consecutive patients were studied - nine with non-cardiac chest pain and 41 with a history of heartburn. Symptomatic reflux was defined as a greater than or equal to 50% temporal association between pain episodes and reflux events (pH less than 4) during pH monitoring. A positive acid perfusion test (in which the patient's usual symptoms were evoked by acid, though not saline) had a 100% sensitivity, 73% specificity, and 81% accuracy for the detection of symptomatic reflux. All 10 patients with symptomatic reflux during pH monitoring had evidence of mucosal acid sensitivity. A negative acid perfusion test made symptomatic reflux unlikely. However, symptomatic reflux or a positive acid perfusion test, or both, were found in some patients with a normal oesophageal acid exposure time during pH monitoring. Mucosal acid sensitivity, abnormal oesophageal acid exposure time, and symptomatic reflux should be regarded as separate, though related aspects of reflux disease. The Bernstein test is simple, safe, and easily performed. A positive test helps to identify an oesophageal cause of symptoms, particularly in patients in whom other aspects of 'gastro-oesophageal reflux disease' are absent, or who do not have symptoms during pH monitoring.

Adult↗
PubMed2001

Microembolic signal detection in patients with symptomatic and asymptomatic lone atrial fibrillation.

BACKGROUND AND PURPOSE: There are few data on the occurrence of microembolic signals (MES) in patients with lone atrial fibrillation (LAF). The aim of this work was to systematically study the frequency of MES in patients with symptomatic and asymptomatic LAF and to compare it with that of nonvalvular atrial fibrillation (NVAF). METHODS: 37 consecutive acute stroke patients with LAF, 10 asymptomatic patients with LAF and 100 age-matched healthy controls were studied. Another 92 stroke patients with known NVAF were included in the study to compare patients with LAF regarding the presence of MES. Both middle cerebral arteries were monitored by transcranial Doppler ultrasound for at least 30 min at admission and after 1 week in symptomatic and asymptomatic patients with LAF. All patients with LAF were followed up for a mean duration of 18 months, and recurrent strokes were registered. RESULTS: MES was detected in 11 (29%) symptomatic patients with LAF but only in 1 asymptomatic patient with LAF (chi(2) = 11.3; p = 0.0008) and in no control subjects (chi(2) = 106; p = 0.00001). There was no difference in the frequency of MES-positive patients and the number of MES between subjects with symptomatic LAF and known NVAF (29% in both groups; mean count, 16 +/- 4 vs. 17 +/- 6; p = 0.73). In patients with symptomatic LAF and NVAF who underwent anticoagulant therapy, there was no difference in the frequency of MES after 1 week of hospitalization (chi(2) = 1.53; p = 0.2). During a mean follow-up period of 18 months, 1 patient with symptomatic LAF and MES had a recurrent ischemic event 1 year after the first stroke and none of those with asymptomatic LAF had any events. CONCLUSION: Our study suggests that asymptomatic and paroxysmal LAF with a lower frequency of MES is a benign disorder compared to chronic and symptomatic LAF with a higher frequency of MES. Further studies need to justify whether MES has a predictive value in patients with chronic LAF who are prone to ischemic stroke.

Adult↗
PubMed2006

Microarray analysis reveals overexpression of CD163 and HO-1 in symptomatic carotid plaques.

OBJECTIVE: We studied by microarray analysis whether symptomatic and asymptomatic carotid plaques from the same patient differ in gene expression and whether the same changes are present in an independent sample set. METHODS AND RESULTS: Carotid plaques from four patients with bilateral high-grade stenosis, one being symptomatic and the other asymptomatic, were analyzed on Affymetrix U95Av2 arrays. 33 genes showed >1.5-fold change between symptomatic and asymptomatic plaques in an intraindividual comparison with FDR ranging from 0.28 to 0.40. Three genes involved in iron-heme homeostasis, CD163, HO-1, and transferrin receptor, were further analyzed in 40 independent plaques. HO-1 (fold-change 1.93, 95%CI 1.04 to 3.94, P=0.040) and CD163 (1.58, 1.11 to 2.40, P=0.013) mRNAs were again induced, and also HO-1 protein was overexpressed in symptomatic plaques (4.38, 1.54 to 12.20, P=0.024). The expression of HO-1 and CD163 correlated with tissue iron content but iron itself was not associated with the symptom status. CONCLUSIONS: Symptomatic plaques show overexpression of CD163 and HO-1 both in intraindividual and interindividual comparison. Their expression correlates with iron deposits but asymptomatic and symptomatic plaques from isolated patients do not differ in macroscopic hemorrhages or iron deposits. We suggest that symptomatic plaques show a more pronounced induction of CD163 and HO-1 in response to plaque hemorrhages.

Aged↗
PubMed1994

Cerebral blood flow reserve assessment in symptomatic versus asymptomatic high-grade internal carotid artery stenosis.

BACKGROUND AND PURPOSE: Thromboembolic stroke is likely to occur in patients with a restricted cerebral blood flow reserve. Our aims were to determine (1) whether symptomatic patients had any significant hemodynamic restriction ipsilateral to carotid occlusive disease compared with patients whose carotid stenosis is asymptomatic and (2) whether patients with carotid occlusive disease have impaired cerebral perfusion reserve compared with control subjects. METHODS: We compared cerebral blood flow and collateral capacity using the 133Xe inhalation method and acetazolamide test in symptomatic (n = 10) and asymptomatic (n = 10) patients who had a high-grade internal carotid artery stenosis (range, 70% to 99%). Results were compared with those from 10 healthy control subjects. RESULTS: Mean baseline cerebral blood flow was 40.29 +/- 1.38 mL/100 g per minute on the symptomatic side in symptomatic patients versus 45.20 +/- 2.53 mL/100 g per minute on the lesion side in asymptomatic patients (control subjects, 46.91 +/- 2.11 mL/100 g per minute in the right hemisphere versus 46.17 +/- 1.93 mL/100 g per minute in the left). There was no statistical difference between patients in symptomatic and asymptomatic groups versus control subjects (P > .10). Mean cerebral blood flow increase after acetazolamide was in the same range in symptomatic (52.89 +/- 2.54 mL/100 g per minute) and asymptomatic (56.22 +/- 3.35 mL/100 g per minute) patients (P > .10), and no difference was observed regarding control subjects (54.25 +/- 2.94 mL/100 g per minute; P > .10). Three asymptomatic and two symptomatic patients and three control subjects had no significant cerebral blood flow increase after acetazolamide. CONCLUSIONS: An additional hemodynamic factor in thromboembolic ischemia related to severe unilateral carotid stenosis might be an unusual finding in patients without apparent hemodynamic induction of symptoms. The lack of significant variation in postacetazolamide cerebral blood flow in some patients and control subjects implies that this procedure may be inconsistent in assessing the cerebral perfusion reserve in the individual case.

Acetazolamide↗
PubMed2001

Increased CD8(+) T cells associated with Chlamydia pneumoniae in symptomatic carotid plaque.

BACKGROUND AND PURPOSE: The presence of Chlamydia pneumoniae has been reported in carotid atheroma, but its causative effect in the activation of an atherosclerotic plaque to a prothrombotic state remains unproved. Antigen- mediated activation of T lymphocytes within plaque may represent a mechanism by which infection can result in plaque conversion. The goal of the present study was to characterize the T-cell subtype profile related to the presence of C pneumoniae in patients with symptomatic versus asymptomatic carotid atherosclerosis. METHODS: We studied 14 plaques (5 symptomatic and 9 asymptomatic) positive for C pneumoniae confirmed by polymerase chain reaction and 14 plaques (6 symptomatic and 8 asymptomatic) from age- and stenosis-matched patients negative for C pneumoniae by polymerase chain reaction. T-cell subpopulations of T-helper, T-cytotoxic, and T-memory lymphocytes were identified through indirect enzyme immunohistochemistry with anti-CD3+, anti-CD4+, anti-CD8+, and anti-CD45RO+ monoclonal antibodies, respectively. Results are expressed as the number of positive cells per millimeter squared. RESULTS: In the absence of C pneumoniae, symptomatic plaques had a modest but significant increase of CD3+ (89.6 versus 55.3, P=0.013), CD4+ (57.3 versus 32.7, P=0.01), and CD45RO+ (82.8 versus 43.7, P=0.007), but not CD8+ T cells (28.5 versus 25.5, P=0.245) compared with asymptomatic. However, in the presence of C pneumoniae, there was significant increase of all T-lymphocyte subtypes in symptomatic plaques, including CD8+ (76.8 versus 30.3, P=0.03), CD3+ (192.1 versus 80.4, P=0.004), CD4+ (111.9 versus 37.9, P=0.003), and CD45RO+ (120.2 versus 72.9, P=0.003) cells compared with asymptomatic plaques. With use of 2-way ANOVA, both the presence of chlamydia and symptoms were associated with significantly higher T-cell counts (P<0.005 for all subtypes). CONCLUSIONS: Although all patients with symptomatic disease show a modest elevation in the concentration of intraplaque lymphocytes, a preferential increase in CD8+ class I-restricted T cells is observed in symptomatic carotid plaque positive for C pneumoniae. These data provide incentive to further explore the role of Chlamydia in the modification of immune-mediated mechanisms in active atherosclerotic plaque.

Aged↗
PubMed2005

Symptomatic treatment of migraine in children: a systematic review of medication trials.

OBJECTIVE: Treatment of pediatric migraine includes an individually tailored regimen of both nonpharmacologic and pharmacologic measures. The mainstay of symptomatic treatment in children with migraine is intermittent oral or suppository analgesics, but there is no coherent body of evidence on symptomatic treatment of childhood migraine available. The objective of this review is to describe and assess the evidence from randomized and clinical controlled trials concerning the efficacy and tolerability of symptomatic treatment of migraine in children. DESIGN: Systematic review according to the standards of the Cochrane Collaboration. METHODS: Databases were searched from inception to June 2004. Additional reference checking was performed. Two authors independently selected randomized and controlled trials evaluating the effects of symptomatic treatment in children (<18 years old) with migraine, using headache (HA) clinical improvement as an outcome measure. Two authors assessed trial quality independently by using the Delphi list, and data were extracted from the original reports by using standardized forms. Quantitative and qualitative analysis was conducted according to type of intervention. RESULTS: A total of 10 trials were included in this review, of which 6 studies were considered to be of high quality. The number of included participants in each trial ranged from 14 to 653, with a total of 1575 patients included in this review. Mean dropout rate was 19.8% (range: 0-39.1%), and the mean age of participants was 11.7 +/- 2.2 years (range: 4-18 years). All studies used HA diaries to assess outcomes. In most studies, a measure of clinical improvement was calculated by using these diaries. Improvement often was regarded as being clinically relevant when the patients' HA declined by > or =50%. Regarding oral analgesic treatment, the effectiveness of acetaminophen, ibuprofen, and nimesulide were evaluated. When compared with placebo, acetaminophen (relative risk [RR]: 1.5; 95% confidence interval [CI]: 1.0-2.1) and ibuprofen (pooled RR: 1.5; 95% CI: 1.2-1.9) significantly reduced HAs. We conclude that there is moderate evidence that both acetaminophen and ibuprofen are more effective in reduction of symptoms 1 and 2 hours after intake than placebo with minor adverse effects. No clear differences in effect were found between acetaminophen and ibuprofen or nimesulide. Regarding the nonanalgesic interventions, nasal-spray sumatriptan, oral sumatriptan, oral rizatriptan, oral dihydroergotamine, intravenous prochlorperazine, and ketorolac were evaluated. When compared with placebo, nasal-spray sumatriptan (pooled RR: 1.4; 95% CI: 1.2-1.7) seemed to significantly reduce HAs. We conclude that there is moderate evidence that nasal-spray sumatriptan is more effective in reduction of symptoms than placebo but with significantly more adverse events. No differences in effect were found between oral triptans and placebo. All medications were well tolerated, but significantly more adverse events were reported for nasal-spray sumatriptan compared with placebo. We also conclude that there is moderate evidence that intravenous prochlorperazine is more effective than intravenous ketorolac in the reduction of symptoms 1 hour after intake. No differences in effect were found between oral dihydroergotamine and placebo. CONCLUSIONS: Acetaminophen, ibuprofen, and nasal-spray sumatriptan are all effective symptomatic pharmacologic treatments for episodes of migraine in children. The new frontier for symptomatic treatment is likely to be the development of triptan agents for use in children. Most treatments have only been evaluated in 1 or 2 studies, which limits the generalizability of the findings. We strongly recommend performing a large, high-quality randomized, controlled trial evaluating different symptomatic medications compared with each other or to placebo treatment. Favorable high-quality studies should be performed and reported according to the CONSORT statement. Clinical improvement of HA should be used as the primary outcome measure, but quality of life, days missed at school, and satisfaction of child or parents should also be used as an outcome measure in future studies.

Acetaminophen↗
PubMed2003

Incidental and symptomatic renal tumors: impact on patient survival.

CONTEXT: Renal cell carcinoma is the third most frequent genitourinary neoplasia, and there is currently an increase in the incidental diagnosis of tumors confined to the kidneys. OBJECTIVE: To study the survival of patients with incidental and symptomatic renal tumors who have undergone nephrectomy. DESIGN: Retrospective. SETTING: Hospital Sírio Libanês and Hospital Beneficência Portuguesa de São Paulo. PARTICIPANTS: 115 patients with diagnosis of renal cell carcinoma, operated on by the same group of surgeons and evaluated by a single pathologist. MAIN MEASUREMENTS: Sex, age and diagnosis method, analyzed in two groups, according to the tumor diagnosis: Group 1 with incidental diagnosis and Group 2 with symptomatic tumors. The anatomopathological characteristics and patient survival in both groups were evaluated. A statistical analysis was performed using the Student t, chi-squared, log rank and Kaplan-Meyer tests. RESULTS: Among the studied patients, 59(51%) had an incidental diagnosis, with 78% diagnosed by ultrasonography, 20% by computerized tomography scan and 2% during surgeries; 56 patients (49%) were symptomatic. Tumor locations were equally distributed between the two kidneys, and the surgery was conservative for 24% of the incidental and 9% of the symptomatic group. In the incidental group only one patient had tumor progression and there was no death, while in the symptomatic group there were 5 progressions and 10 deaths. The 5-year specific cancer-free survival was 100% in the incidental and 80% in the symptomatic group (p = 0.001) while the disease-free rate was 98% in the incidental and 62% in the symptomatic group (p < 0001). CONCLUSION: Incidental renal tumor diagnosis offers better prognosis, providing longer disease-free survival.

Adolescent↗
PubMed1993

Sequential changes in the platelet count in patients with symptomatic vasospasm after subarachnoid hemorrhage.

The platelet count in 110 patients with subarachnoid hemorrhage (SAH) was analyzed retrospectively. Changes in the platelet count in 102 patients undergoing intracranial aneurysm surgery showed that the minimum platelet count was similar in patients with and without symptomatic vasospasm, but the minimum occurred later in symptomatic vasospasm patients, regardless of Hunt and Hess grade or operation timing. Sixty-five of 67 non-symptomatic vasospasm patients (97%) showed the minimum platelet count within 4 days of SAH and two (3%) on the 5th day. In contrast, only 10 of 35 symptomatic vasospasm patients (29%) showed a minimum platelet count within 4 days after SAH and 25 (71%) between the 5th and 11th days. Analysis of the eight patients not receiving surgery showed that the minimum platelet count occurred 2 days after SAH in two non-symptomatic vasospasm patients, but after the 5th day in five of six symptomatic vasospasm patients. Therefore, monitoring of the platelet count can provide an indicator of the occurrence of symptomatic vasospasm.

Adult↗
PubMed1996

Accuracy of sonography in the evaluation of calf deep vein thrombosis in both postoperative surveillance and symptomatic patients.

OBJECTIVE: The purpose of this study was to determine the accuracy and to assess the interobserver variability of compression sonography (CS) in detecting isolated calf deep vein thrombosis (DVT) in postoperative and symptomatic patients without clinical or contrast venographic indication of previous lower extremity DVT. SUBJECTS AND METHODS: A prospective double-blinded study was undertaken on 287 consecutive legs using contrast venography (CV) as the gold standard. One hundred seventy-nine legs were from the postoperative group, and 108 legs were from the symptomatic group. The CS technique was used to diagnose DVT, and color Doppler imaging was used only as a road map. Calves were examined while the patient was sitting. Also, interobserver agreement was measured in the CS evaluation of calf veins of another group of 54 symptomatic legs. RESULTS: Forty (22%) CVs and 13 (7%) CS examinations for calf assessment were indeterminate in the postoperative group as compared with 33 (30%) and 10 (9%) in the symptomatic group. The sensitivity, specificity, negative predictive value, and positive predictive value of CS in detecting calf DVT with or without extension to above-the-calf veins were 92% (confidence interval [Cl], 82-100%), 100%, 98% (Cl, 95-100%), and 100%, respectively, in the postoperative group and 86% (Cl, 72-100%), 96% (Cl, 90-100%), 94% (Cl, 87-100%), and 90% (Cl, 77-100%), respectively, in the symptomatic group. The sensitivity of CS was 92% (Cl, 81-100%) in the postoperative and 88% (CL, 65-100%) in the symptomatic group with isolated calf DVT. Of all calf muscular branch DVTs, 52% were detected by CS alone as compared with 21% seen on CV alone. The kappa value for the CS assessment of isolated calf vein DVTs was 0.60. CONCLUSION: Sonography is a highly accurate test with acceptable reproducibility for the detection of DVT in calf veins in both postoperative and symptomatic patients. Technically adequate calf assessment can be achieved in the majority of patients if the calf examination is performed with the patient sitting.

Adult↗
PubMed1998

The relation of physical activity to risk for symptomatic gallstone disease in men.

BACKGROUND: Gallstone disease is a major source of morbidity in the United States. Gallstones are twice as common in women as in men, but severe biliary events leading to surgery occur with equal frequency in the two sexes. OBJECTIVE: To determine whether physical activity decreases risk for symptomatic gallstone disease in men. DESIGN: Prospective cohort study. SETTING: U.S. male health professionals. PATIENTS: 45,813 men 40 to 75 years of age were followed from 1986 to 1994. MEASUREMENTS: Questionnaires mailed in 1986, 1988, 1990, 1992, and 1994 asked about physical activity, incidence of gallstone disease, age, body weight, dietary and alcohol intake, smoking habits, use of medications, and occurrence of diagnosed medical conditions other than gallstone disease. RESULTS: 828 men reported having newly symptomatic gallstones (diagnosed by ultrasonography or radiography) or undergoing cholecystectomy for recent symptoms. After adjustment for multiple confounders, increased physical activity was inversely related to risk for symptomatic gallstone disease. When extreme quintiles were compared, men younger than 65 years of age had a stronger inverse association (multivariate relative risk, 0.58 [95% CI, 0.44 to 0.78]) with risk than did men 65 years of age or older (relative risk, 0.75 [CI, 0.52 to 1.09]). In contrast, sedentary behavior was positively related to risk for symptomatic gallstone disease. Men who watched television more than 40 hours per week had a higher risk for symptomatic gallstones than men who watched less than 6 hours per week (relative risk for older men, 3.32 [CI, 1.51 to 7.27]; relative risk for younger men, 1.58 [CI, 0.38 to 6.48]). CONCLUSIONS: Physical activity may play an important role in the prevention of symptomatic gallstone disease in men even beyond its benefit for control of body weight. The results of this study indicate that 34% of cases of symptomatic gallstone disease in men could be prevented by increasing exercise to 30 minutes of endurance-type training five times per week.

Adult↗
PubMed2002

[Surgical treatment of progressive and symptomatic retinal detachment in senile retinoschisis].

BACKGROUND: This is 23-years retrospective study of consecutive, non-selected patients with senile retinoschisis and rare progressive and symptomatic retinal detachment (RD). The presence of RD was manifested by spectrum of retinal pathology of inner and outer layers of senile retinoschisis, ranging from simple holes to giant tears with or without proliferative vitreoretinopathy. The goals of this study were: 1--to evaluate the characteristics of the progressive and symptomatic RD based on detail preoperative examination of the eye, 2--to evaluate the anatomic and functional results of RD surgery. PATIENTS AND METHODS: From 1978 to 1999, RD surgery was performed on 57 eyes of 55 patients (28 men and 27 women) with senile retinoschisis and progressive and symptomatic RD. On average, we observed the patients for approximately 11.3 years after surgery; the minimum follow-up period was 20 months. The patients were divided in two groups according to the preoperative findings and the surgical procedures. Based on the size and the location of the defects of the inner and outer layer of senile retinoschisis and the proliferative vitreoretinopathy these procedures were indicated: 1--Uncomplicated cases of progressive and symptomatic retinal detachment were operated on primary cryopexy and scleral buckling (CSB) with episcleral silicone implants in 45 eyes. 2--Complicated cases of progressive and symptomatic retinal detachment underwent a pars plana vitrectomy (PPV) in 12 eyes: a--primary PPV was used as the primary treatment method in 6 eyes, b--secondary PPV as a secondary treatment method after unsuccessfully primary CSB with episcleral silicone implants in next 6 eyes. RESULTS: Characteristics preoperative findings were: RD in two or more quadrants in 84.2% of the eyes, including macula region in 71.9% of the eyes. Defect of the outer layer of senile retinoschisis was located postequatorial in 80% of the eyes, large retinal tears were found in 53.3% of the eyes and single defect was diagnosed in 68.8% of the eyes. Defect the of inner layer of senile retinoschisis was located equatorial in 69.5% of the eyes, small defects were found in 78.2% of the eyes and multiple defects were diagnosed in 58.6% of the eyes. Defects of the outer and the inner layer of senile retinoschisis were diagnosed in the equal quadrant in 61.4% of the eyes. The results of surgery varied, depending on the size and location of the defects of the inner and outer layer of senile retinoschisis and proliferative vitreoretinopathy: 1--The complete retinal reattachment in group treated with CSB was achieved in 43 eyes (95.5%), the average visual acuity was 0.34-2--The complete retinal reattachment in group treated with PPV was achieved by: a--primary PPV in six eyes, the average visual acuity was 0.37, b--secondary PPV four eyes, the average visual acuity was 0.16. CONCLUSIONS: Characteristic of senile retinoschisis, especially its defects of inner and outer layers is important preoperative finding for optimal indication of primary surgical treatment of progressive and symptomatic retinal detachment. According to our clinical experiences we created the syllabus of the care about the senile retinoschisis and syllabus of surgical treatment of progressive and symptomatic RD. Standard surgical procedures are the CSB and in the last period also primary PPV.

Adult↗
PubMed2003

[Helicobacter pylori infection in a group of symptomatic and asymptomatic children and adolescents in the Czech Republic].

BACKGROUND: There exist only inconsistent results of studies on the relationship between Helicobacter pylori (H. pylori) infection and functional dyspepsia and/or recurrent abdominal pain in children and adolescents. The answer could bring a comparison of the epidemiological features of H. pylori infection between children and adolescents with dyspepsia and/or recurrent abdominal pain (symptomatic) and without these symptoms (asymptomatic), living in the Czech republic. METHODS AND RESULTS: Study includes children and adolescents (2-18 years) with upper gastrointestinal symptoms visiting paediatric gastroenterology department between 1994 and 1999. Age, sex, socioeconomic level matched control (asymptomatic) group consisted of children and adolescents visiting the general paediatric service with symptoms not related to the upper gastrointestinal tract. Demographic and socioeconomic factors, including parent(s) educational level, place of residence, living conditions, type of drinking water and pets in their household were evaluated. Serum of the children and adolescents was tested for H. pylori IgG by enzyme linked immunosorbent assay. In addition, the symptomatic children and adolescents underwent endoscopic examination and biopsies from gastric antrum and corpus were taken for the quick urease test, histology/histoscopy, and H. pylori cultivation. H. pylori infection in this group was stated when at least two tests were positive. Altogether 829 children and adolescents were examined, 624 cases were symptomatic and 205 represented controls (asymptomatic). The prevalence of infection was 33% among symptomatic children vs. 7.5% among controls (OR = 6.2, p.001) and was similar among boys and girls (32% vs. 34.5%, respectively). H. pylori prevalence increased with age among symptomatic children (10% for children below 6 years and 37% between 11 to 16 years) (p.001). In contrary, prevalence tended to fall with age among asymptomatic children (11% in children below 6 years vs. 6% in children over 10 years (OR = 2.0, 95% CI = 0.7-6.2). In both groups, an inverse correlation between H. pylori occurrence and mother's educational level was observed. The H. pylori incidence was 10% among asymptomatic children who drank water from municipal water supply or from a well vs. 3% among those who drank bottled water (OR = 4, 95% CI = 1.1 to 18, p.05). CONCLUSIONS: H. pylori infection was more prevalent among symptomatic children and adolescents vs. asymptomatic children and adolescents within the same population. H. pylori incidence increased with age among symptomatic children and adolescents and tended to fall among controls, showing deep differences between the two groups. With exception of the bottled water drinking, presence of any other factor studied represented significant risk for acquiring the H. pylori infection.

Adolescent↗
PubMed2004

[The clinical characteristics of symptomatic propylthiouracil-induced hepatic injury in patients with hyperthyroidism].

OBJECTIVE: To study the clinical characteristics and factors of symptomatic propylthiouracil (PTU)-induced hepatic injury in patients with hyperthyroidism. METHODS: A retrospective study of the patients diagnosed with symptomatic PTU-induced hepatic injury, admitted to Peking Union Medical College (PUMC) Hospital from January 1993 to December 2002, were carried out with regard to clinical characteristics, laboratory findings and management. In addition, a comparative study was carried out in hyperthyroidism with symptomatic, asymptomatic and without PTU-induced hepatic injury at the same time. Symptomatic PTU induced hepatic injury was defined as the development of hepatitis symptoms or jaundice with at least 3-times elevation of liver function test without other causes. RESULTS: Nine hundred fourteen patients were admitted to PUMC Hospital from January 1993 to December 2002. Clinically overt symptomatic hepatic injury developed in twelve patients [1.3%, age (30 +/- 9) yr, male:female ratio, 1:11] between 7 and 77days after PTU administration. Abdominal distention and fatigue developed in all patients. Serum level of ALT and total bilirubin (TBil) increased to (531.7 +/- 352.0) 113 - 1425 U/L and 67.6 (17.1 - 567.7) micro mol/L, respectively. Prothrombin time prolonged in three cases and plasma ammonia elevated in one case. The types of hepatic injury were hepatocellular in eight, cholestatic in one and mixed in two. None resulted from viral hepatitis and autoimmune hepatitis. There was significant difference in history of side effects of antithyroid agents, PTU dose and abnormal ratio of serum ALT among patients with symptomatic, asymptomatic and without hepatic injury (P < 0.05). However, there were no statistic differences in age, sex, serum levels of T(4), T(3), and increased thyroglobulin antibody, thyroid peroxidase antibody and thyrotrophin receptor antibody at initial diagnosis. The liver function test normalized in all patients from 14 to 140 days after the PTU withdrawal. CONCLUSIONS: Symptomatic hepatic injury usually develops with PTU administration in the first few months, though it is unusual. It may be difficult to predict its development and the patient should be monitored for the liver function in the early stage of PTU administration.

Adolescent↗
PubMed2005

[Clinical characteristics in non-symptomatic infants with tuberculosis whose diagnostic clue was regular tuberculin skin test prior to BCG vaccination].

OBJECTIVE: Tuberculin skin test (TST) is a useful tool to find non-symptomatic infants with tuberculosis. In 2005, Japanese government starts direct BCG vaccination without prior TST, and we may miss one of the chances to find the above patients. In this study, we tried to find if there is any clinical examination to find non-symptomatic infants with tuberculosis instead of regular TST. SUBJECTS AND METHODS: We found out 20 non-symptomatic infants with tuberculosis among 131 infants who referred to our clinic because of positive TST prior to BCG vaccination from 1996 to 2003. We examined the data of gastric aspirate examination for Mycobacterium tuberculosis, complete blood counts, and serum chemistries in the 20 infants with tuberculosis. We also tried to find out the source of tuberculosis of these patients by the contact investigation. RESULTS: Induration of TST among 20 non-symptomatic infants with tuberculosis were 7 to 26 (median, 13.5) mm. Mycobacterium tuberculosis from gastric aspirates was positive in 13 infants (65%). The level of blood hemoglobin was more than 11 g/dl in all infants. The white blood cell count was increased in 6 infants (30%), and exaggerated lymphocyte predominance was recognized in 8 infants (40%). Serum CRP was normal, or subtly increased. Serum GOT (AST) was increased in 15 infants (75%), though the reason was unknown. Serum albumin was normal in all the infants. In the contact investigation, suspected sources were found in 11 infants (55%), and 6 out of 11 sources (55%) were their mothers. Nine sources did not belong to the risk groups for tuberculosis except two mothers coming from tuberculosis epidemic countries. CONCLUSION: In 20 non-symptomatic infants with tuberculosis, examination of gastric aspirate for Mycobacterium tuberculosis, TST, and chest imaging were useful tools to diagnose tuberculosis. However, these examinations are not done in non-symptomatic infants. Eleven family members who might infect the infants were found by the contact investigations, and none of them realized that they have tuberculosis. Our study suggests that there is no realistic clue to find non-symptomatic infants with tuberculosis instead of regular TST, and that the control of infant's tuberculosis still depends on the examination of close contacts of sporadic adult patients with tuberculosis.

BCG Vaccine↗