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At least 1,297 records · Page 72Linked to original sources
PubMed2002

Infant seizures not so infantile: first-time seizures in children under six months of age presenting to the ED.

Data regarding first-time seizures in children 6 months of age in whom febrile seizures and idiopathic seizure disorders are most common, a large percentage of children <or=6 months of age presenting with first-time seizures have significant underlying pathology. This pathology often includes immediately life-threatening conditions in these children who may look deceptively well on initial evaluation.

Blood Cell Count↗
PubMed2000

D-lactic acidosis 23 years after jejuno-ileal bypass.

Accumulation of D-lactate after gastrointestinal surgery, particularly jejuno-ileal bypass, is an uncommon and often misdiagnosed clinical disturbance. The syndrome may be complicated by dizziness, ataxia, confusion, headache, memory loss, and aggressive behavior. Serum chemistries are often deceptive because the anion gap is frequently normal in spite of severe metabolic acidosis. Moreover, the urine anion gap may be positive, incorrectly suggesting a defect in renal net acid excretion. Indeed, the combination of a normal anion gap metabolic acidosis and positive urine anion gap may erroneously suggest a diagnosis of renal tubular acidosis. Importantly, all reported cases of D-lactic acidosis secondary to bypass surgery have been encountered within 5 to 10 years following the surgery. Here we present an unusual case of D-lactic acidosis (complicated by encephalopathy) presenting 23 years after a jejuno-ileal bypass procedure. The patient was initially diagnosed with a drug intoxication secondary to benzodiazepines. Ultimately, the diagnosis of D-lactate encephalopathy was established after challenging the patient with a carbohydrate load. Thus, administration of 40 kcal/kg over 16 hours reproduced the clinical syndrome and was accompanied by a marked increment in serum and urine D-lactate concentration. The patient had sustained resolution of her symptoms after treatment with oral vancomycin.

Acidosis, Lactic↗
PubMed1999

The pathogenesis of obesity.

Obesity is an extremely challenging medical condition because it is a multifactorial disease that lies at the interface between the biology of body energy regulation and an environment (physical and sensory) that has been increasingly characterized as 'hostile to good health'. The deceptively straightforward anthropomorphic definition of obesity is the excessive accumulation of body fat. However, obesity is a chronic disease that is much more than excessive fat. It involves genetic predisposition and metabolic, hormonal and behavioural aspects and results in significant morbidity, reduced quality of life, discrimination and early mortality. The development and maintenance of obesity can be considered to result from the integration, or the accumulation, of small daily errors in energy balance over several months and years. The biological factors involved increase the predisposition toward the expansion of adipose tissue mass together with the consequences of an environment that promotes increased food intake and decreased physical activity. Multiple aetiologies may result in similar degrees of obesity.

Animals↗
PubMed2002

Endometrioid carcinoma of the endometrium with an invasive component of minimal deviation carcinoma.

Minimal deviation endometrioid adenocarcinoma is a rare pathological variant of endometrioid adenocarcinoma. We describe a case representing another rare variant of endometrioid adenocarcinoma composed of both typical and minimal deviation endometrioid adenocarcinoma in a 45-year-old woman. Macroscopically, the cervix was of normal size but it had an indurated consistency. The myometrium was unremarkable. Microscopically, in addition to the typical endometrioid adenocarcinoma that involved 75% of the endometrium, there was a proliferation of mildly atypical endometrial type glands sparsely distributed in the fibrovascular tissue, typical of minimal deviation endometrioid adenocarcinoma. The latter component extended downward from the endomyometrial junction and involved focal areas of the uterine body and isthmus, diffusely invaded the entire cervix and focally the cervical resection margins. Focal transitional areas between typical and minimal deviation endometrioid adenocarcinoma were identified. Due to a relatively normal gross appearance and the microscopic deceptively benign looking appearance, minimal deviation endometrioid adenocarcinoma may pose problems of obtaining adequate sampling and evaluating the thickness of invasion of the endometrial carcinoma on gross, as well as microscopic, examination. HUM PATHOL 33:856-858.

Carcinoembryonic Antigen↗
PubMedDate not supplied

Postoperative toxic shock syndrome after excision of a ganglion cyst from the ankle.

Postoperative toxic shock syndrome (PTSS) after orthopedic surgery is rare, but early recognition and prompt intervention are essential to minimize morbidity and potential mortality. The diagnosis should be considered in all postoperative patients presenting with fever, hypotension, and systemic illness. The treating surgeon must have not only knowledge of the clinical entity, but also an extremely high index of suspicion, because the diagnosis can be elusive with surgical wounds appearing deceptively benign. Treatment consists of antibiotics, surgical wound debridement, and, more importantly, aggressive supportive care with intravenous fluids and intensive care surveillance. To date, the literature contains relatively few case reports of PTSS after orthopedic procedures, with even fewer cases encountered after foot and ankle surgery. This report describes a patient who developed the rare complication of PTSS after an elective ganglion cyst excision from the ankle.

Ankle↗
PubMed2005

Outbreak of Marburg hemorrhagic fever in Angola: a review of the history of the disease and its biological aspects.

Transmission of a dangerous infectious disease threatens not merely a local population but the world at large as the result of immigration and increased and faster travel. Any outbreak elicits considerable concern and demands that various precautionary methods be instituted and that the disease be contained as quickly as possible. Recently, an old disease, one that may have been present for centuries and was identified decades ago, reared its ugly head, killing more than 200 people before it was contained. Fortunately, the disease, Marburg hemorrhagic fever, was limited to a small geographic area, but the devastation of lives was much greater than that of many epidemics and was a warning of the numerous factors, including fear, lack of understanding, and deception, that can exacerbate the spread of disease and hinder implementation of restraints. This article reviews the history of the disease caused by Marburg virus and its biological components.

Angola↗
PubMed2001

Cystic ameloblastoma--behavior and treatment of 21 cases.

PURPOSE: This article presents a series of cystic ameloblastomas in which an unexpected capacity for bony destruction and recurrence was shown. Proliferation rates were evaluated to see if there is a correlation to the biologic behavior of these lesions. MATERIALS AND METHODS: Clinical and histologic material on 21 consecutive cystic ameloblastomas was retrieved and reviewed. Immunohistochemical analysis of proliferation-associated Ki-67 protein was carried out to determine mitotic indices for 10 cystic ameloblastomas, and these were compared to 10 solid ameloblastomas and 10. dentigerous cysts. RESULTS: Lesions from 10 males and 11 females (age range, 12 to 72 years; mean age, 35 years) were included. All lesions were in the mandible; 18 in posterior sites. Lesion size ranged from 2 to 8 cm in greatest dimension. Cortical perforation was evident in 7 lesions, and multilocularity (more often in older patients) was evident in 6 lesions. Recurrences were seen in 9 cases (43%), and the time between initial treatment and recurrence was as long as 10 years. The characteristic histopathologic feature was a thin, stratified squamous cystic lining with spongiosis and basal palisades. Ten cases also showed mural invasion, and 4 had plexiform luminal proliferation. The proliferation rate of the cystic ameloblastomas (represented as a percentage of cells in cell cycle) was 4.3%, compared with solid tumors at 2.8% and dentigerous cysts at 6.6%. CONCLUSIONS: Cystic ameloblastomas occur within a wide age range, but at slightly lower mean age than solid lesions. There is a very strong predilection for the mandible, and there appears to be no gender difference. Lesions frequently become large, destructive, and/or multilocular. There is a significant recurrence potential, and extended follow-up is advisable. The deceptively innocent histology of cystic ameloblastomas belies the biologic potential of these lesions. The mechanism(s) by which cystic ameloblastomas gain their destructive behavior seems less likely associated with acceleration of the cell cycle than with other factors. Simple enucleation or curettage of these lesions may be inappropriate treatment.

Adolescent↗
PubMedDate not supplied

IRB-identified ethical issues in nursing research.

Ethical issues in nursing research protocols submitted to a School of Nursing institutional review board (IRB) were identified by examining the letters sent to researchers whose protocols required revision or were not-approved. Themes were extracted from the ethical issues and placed into the following categories: The informed consent document, barriers to informed consent, subject benefit, subject risk, confidentiality, and problems with specific populations. The protocols were coded by the researcher's status (student/nonstudent), type of review (expedited/full committee), vulnerability of the population (vulnerable/nonvulnerable), and the type of subject (healthy volunteer/at-risk/patient/family/provider). A total of 157 protocols were examined; of these, 45.9 per cent were approved without requiring revision. Revisions were required in 46.5 per cent of the protocols and 8.3 per cent were not-approved. Problems with the form used to document informed consent were found in 43.3 per cent. The next most commonly identified theme was "information needed" in 30.6 per cent of the protocols, followed up by "inadequate explanation of benefit" in 22.3 per cent of protocols. The nursing research protocols in this study were found to be more vulnerable to ethical problems arising from the relationship between the researcher and subject than from physical harm. It is suggested that nurses give extra care to issues of coercion, deception, and attention to problems uncovered in the research process.

Clinical Nursing Research↗
PubMed2001

Pericardial disease in renal patients.

Pericardial disease is common in patients with renal disease. Approximately 20% of uremic patients requiring chronic dialysis develop uremic pericarditis or dialysis pericarditis. In all forms of uremic pericarditis, cardiac tamponade is the main danger. Pericardial contents are sterile unless secondarily infected. Differential diagnosis may be difficult, especially in mentally confused patients and because nonuremic intercurrent pericarditis of any cause is always possible. In uremic patients, frequent autonomic impairment and decreased cardiac adenylate cyclase limit heart rate increases during pericarditis, even during tamponade, so that the heart rate may be deceptively slow even with fever and hypotension. Adequate renal dialysis effectively ends uremic pericarditis. Several factors are associated with precipitating dialysis pericarditis and effusion, above all inadequate dialysis. Pericarditis in hepatorenal failure occurs at relatively low blood urea nitrogen levels and does not respond to dialysis.

Humans↗
PubMed2000

Breast reconstruction by tissue expansion. A retrospective technical review of 197 two-stage delayed reconstructions following mastectomy for malignant breast disease in 189 patients.

Despite the advent of free tissue transfer, breast reconstruction by tissue expansion is an important technique in the armamentarium of the reconstructive breast surgeon. The concept is deceptively simple and yet in reality can produce difficult complications and poor results. A database was compiled of all the patients receiving tissue expanders and/or implants for cosmetic, congenital and reconstructive purposes between 1986 and 1998. 189 patients had 197 delayed two-stage tissue expansion breast reconstructions following mastectomies for malignant breast disease between 1986 and 1997. 103 breasts (52%) had two uncomplicated stages. The remainder had one or more complications, revisional procedures for complications or alterations to the reconstruction for size, position or shape. Overall each breast reconstruction required 2.9 procedures (range 2-9). The complications and additional procedures are discussed. In particular, capsular contracture of the definitive implant (12%) was related to implant type and not to the speed of tissue expansion or the degree or duration of over-expansion. Although 17% of patients received radiotherapy, none of those who developed contracture around the definitive implant had this adjuvant therapy, P< 0.05. Twelve reconstructions (6%) totally failed due to complications of which six underwent secondary flap reconstruction. Twenty-one patients have subsequently developed metastatic disease of which 15 have died to date. Breast reconstruction by tissue expansion is still an important technique. It should be used carefully and thoughtfully by surgeons trained to deal with any complications. Patients need to be carefully selected and counselled prior to undertaking this process.

Adult↗
PubMed2000

[Soft tissue tumors with difficult to distinguish boundaries. From myxoma to myxofibrosarcoma: a case report].

Myxofibrosarcoma is a slow-growing subcutaneous tumor found in the older patient. Because of its deceptive macroscopic and histologic appearance, it is often misinterpreted as a benign lesion. We report a case of this tumor in a young woman recurring five times before the final diagnosis was made. Since recurrence may lead to tumor progression and increases the risk of metastasis, accurate diagnosis and radical removal of the lesion are extremely important. Eight benign and malignant myxoid tumors that have to be considered as differential diagnosis are reviewed.

Adult↗
PubMed2002

[A case of kleptomania?].

We report on a case of kleptomania with manifestation as deceptive ordering by catalogue. The patient is additionally suffering from severe agoraphobia.

Agoraphobia↗
PubMed2003

[Indicators of incipient atherosclerosis: demonstration of endothelial dysfunction with high-resolution ultrasound].

Endothelial function is thought to play a central role in the process of atherosclerosis, and in the pathogenesis of arterial hypertension and chronic heart failure. In the last decade a non-invasive ultrasound technique has been developed to measure endothelium-dependent vasodilation of the brachial artery which allows quantification of endothelial function. This method is based upon results in basic research, which show increased endothelial NO-production following the impact of shear forces on the endothelial surface. The resulting vasodilation can be quantified with high resolution ultrasound (7-13 MHz). The advantage of this technique is its non-invasive nature, which allows a risk-free use even in young individuals. Repeated measurements to control the success of medical intervention are also not problematic. Despite the possibility of widespread use because of its deceptively simple protocol, there are numerous factors affecting flow-mediated vascular reactivity. Details of the methods applied, variations in examination procedure, image acquisition, subjects preparation, equipment, training requirements and data interpretation are reviewed in this paper. Clinical studies of cardiovascular disease, risk factor profiles and the prognostic impact of measuring flow-mediated vasodilation are also discussed.

Arteriosclerosis↗
PubMedDate not supplied

Pollicization in congenital differences.

Pollicization of the index finger is a well established procedure for some cases of thumb hypoplasia. We reviewed our experience of 27 "normal" index-finger pollicizations with a mean follow-up of seven years, excluding those cases with more extensive radial hypoplasia and abnormal fingers. Even in such an "ideal" situation, strength was deceptive and the frequently slender aspect of the new thumb with quite extensive dorsal scar formation and the "cleft" appearance of the first web disappointing. In a prospective series of 32 cases, we tried to improve both the function and appearance of the thumb by modifying the classical incision as well as the transferred muscles and tendons.

Child↗
PubMed2006

Legal examination of physician advertising on the internet.

The Internet provides an invaluable resource to physicians seeking to market healthcare services to consumers. No longer considered an unethical practice, physician advertising has transformed over the years into an indispensable business tool in the medical community. While the Internet creates opportunities to reach vast numbers of individuals in a timely and cost-effective manner, physicians must be vigilant in adhering to laws, rules, and regulations designed to protect the public from false and deceptive practices.

Advertising↗
PubMed1999

[Rehabilitation with bone anchored facial prostheses].

BACKGROUND: Rehabilitation of orbita defects with loss of eyelids is difficult to achieve with plastic surgery. Here defect coverage with a facial prosthesis shows good results. PATIENTS AND METHODS: 105 patients with orbita defects were treated since 1991 with bone anchored facial prostheses. Preoperatively we measured the bone availability with computed tomography. We inserted Brånemark-titanium implants (Fa. Nobel Biocare), with a two-stage procedure. After a period of at least three months we exposed implants and connected the supraconstruction. Then our anaplastologist produced the facial prosthesis, either a "soft" facial prosthesis of silicone or a "solid" prosthesis of polymethylmetacrylate (PMMA). Not later than every three months patients came to recall. RESULTS: For all patients we found enough bone for implantation. The implants were screwed into the lateral bony orbital margin. There were no intraoperative complications accompanying implant insertion. For 96 patients we chose the silicone material; for nine patients we did produce the facial prosthesis of PMMA. In about 10.5% of the implants we had to remove subcutaneous tissue in local anesthesia because of recurrent periimplantary inflammations. Three years after insertion 95.8% of the implants were still firmly anchored in the bone. CONCLUSIONS: Performed by the experienced specialist the prosthetic treatment of orbita defects with a bone anchored facial prosthesis is a cosmetically satisfactory procedure with good long-term outcome. While modern plastic materials can replace the lost tissue with deceptively natural results, the implants guarantee firm secure retention of the facial prosthesis.

Adolescent↗
PubMed2004

Private enforcement: litigation as a tool to prevent obesity.

Private enforcement, or litigation, has played a historic role in protecting public health in the United States. Litigation is often employed as a means to protect public health when government regulation is absent or ineffectual. Litigation has been successfully employed to control both asbestos and tobacco and is poised for success in combating the obesity epidemic. Litigation is effective because it makes public industry practices and increases industry self-policing. Litigation related to obesity would likely employ theories of "unfair and deceptive trade practice" or general "personal injury" or tort claims. While opponents to the use of litigation often cite personal responsibility and the individual as the true locus of liability, these arguments fail to take into account the context of an individual's choice. While litigation can be effective, media attention and current political discourse on "tort reform" has engendered a set of legislative actions that would foreclose litigation as a public health strategy.

Adolescent↗
PubMed2000

Radiographic localization of unerupted mandibular anterior teeth.

The parallax method and the use of 2 radiographs taken at right angles to each other are the 2 methods generally used to accurately localize teeth. For the parallax method, the combination of a rotational panoramic radiograph with an occlusal radiograph is recommended. This combination involves a vertical x-ray tube shift. Three case reports are presented that illustrate: (1) how this combination can accurately localize unerupted mandibular anterior teeth, (2) how a deceptive appearance of the labiolingual position of the unerupted tooth can be produced in an occlusal radiograph, (3) how increasing the vertical angle of the tube for the occlusal radiograph makes the tube shift easier to discern, (4) why occlusal radiographs are preferable to periapical radiographs for tube shifts, and (5) how localization can also be carried out with 2 radiographs at right angles to each other, one of which is an occlusal radiograph taken with the x-ray tube directed along the long axis of the reference tooth.

Adolescent↗