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At least 1,333 records · Page 74Linked to original sources
PubMed1997

Long-term outcome after ileocecal resection for Crohn's disease.

The decision to operate on ileocecal Crohn's disease is usually tempered by concern for early recurrence and the potential for multiple small bowel resections that will render the patients a gastroenterological cripple. However, delays in surgical management may unnecessarily prolong the patient's disease state and risk complications from both medications and unchecked disease. The aim of this study was to report the long-term clinical outcome of patients undergoing ileocecal resection for Crohn's disease between 1970 and 1993. One hundred eighty-one patients underwent ileocecal resection for Crohn's disease during the study period, with a median follow-up of 14.3 years. The mean age at the first resection was 32.7 +/- 0.9 years, and the male female ratio was 79:102. The indications for the initial resection were intractability in 119 (68.4%), obstruction in 45 (25.9%), enteric fistula in 27 (15.5%), perforation in 16 (9.2%), intra-abdominal abscess in 7 (4.0%), and hemorrhage in 5 (2.9%). Postoperative complications included prolonged ileus in 13 (7.5%), pneumonia/atelectasis in 15 (8.6%), wound infection in 11 (6.3%), urinary tract infection in 10 (5.7%), intra-abdominal abscess in 7 (4.0%), and wound dehiscence in 1 (0.6%). There were no operative mortalities. Fifty-six (30.9%) developed a recurrence requiring further surgery, with the mean time interval between initial ileocecal resection and operation for recurrence being 72.3 +/- 7.6 months. A second recurrence developed in 19 patients (10.5%) with a mean time interval of 52.3 +/- 8.3 months. The most frequent sites of first recurrence were the preanastomotic ileum in 49 (87.3%), the postanastomotic colon in 10 (17.9%), other colonic sites in 16 (28.6%), and other small bowel sites in 2 (3.6%) and other sites in 4 (7.1%). The types of resection for first recurrence were ileal resection in 28 (50%), right hemicolectomy in 17 (30.4%), segmental colectomy in 6 (10.7%), total proctocolectomy in 3 (5.4%), and proximal small bowel resection in 2 (3.6%). The long-term follow-up of this patient cohort indicated that 125 (69.1%) had only one resection, 37 (20.4%) required two resections, 15 (8.3%) required three resections, 4 (2.2%) required four resections. The results indicate that ileocecal resection of Crohn's disease had a high rate of disease control obtained with low morbidity, and a low frequency of three or more bowel resections (2.2%). Therefore, surgical resection of ileocecal Crohn's disease should not be unduly delayed for fear of risking short bowel syndrome. This approach should minimize overall disease-related patient morbidity by avoiding long periods of chronic illness.

Adult↗
PubMed1997

Normal and malignant B-cell development with special reference to Hodgkin's disease.

During their development, B lymphocytes are repeatedly selected for the expression of an appropriate surface receptor: the pre-B-cell receptor at the pre-B-cell stage and surface immunoglobulin (Ig) at the transition from a pre-B cell to a mature B cell. Furthermore, stringent selection for B cells expressing high affinity antibodies operates when antigen-activated B cells proliferate within germinal centers (GC). Here, somatic point mutations are introduced into rearranged V region genes at a high rate, and B cells acquiring favorable mutations are selected to differentiate into memory B cells or plasma cells. In the frame of this developmental scheme, extending a recent analysis, we investigated 10 primary cases of Hodgkin's disease (HD) for B-lineage origin and clonality [1]. Single Hodgkin and Reed-Sternberg (H-RS) cells were micromanipulated from frozen tissue sections and analyzed by PCR for rearranged V genes. Clonal VH and/or V kappa/ V delta gene rearrangements were obtained from 9 of the cases. This shows that H-RS cells represent a clonal, B-lineage-derived population of tumor cells. Somatic mutations were found in all clonal VH gene rearrangements. Interestingly, mutations leading to stop codons in in-frame V gene rearrangements were detected in four cases. Since GC B cells acquiring such crippling mutations are usually efficiently eliminated within the GC, the finding of those mutations indicates that H-RS cells are derived from precursors within the GC that escaped apoptosis by a transforming event.

Animals↗
PubMed1997

Iraq's biological weapons. The past as future?

Between 1985 and April 1991, Iraq developed anthrax, botulinum toxin, and aflatoxin for biological warfare; 200 bombs and 25 ballistic missiles laden with biological agents were deployed by the time Operation Desert Storm occurred. Although cause for concern, if used during the Persian Gulf War, Iraq's biological warfare arsenal probably would have been militarily ineffective for 3 reasons: (1) it was small; (2) payload dispersal mechanisms were inefficient; and (3) coalition forces dominated the theater of war (ie, they had overwhelming air superiority and had crippled Iraq's command and control capability). Despite the Gulf War defeat, the Iraqi biological warfare threat has not been extinguished. Saddam Hussein remains in power, and his desire to acquire weapons of mass destruction continues unabated. In this context, the international community must be firm in its enforcement of United Nations resolutions designed to deter Iraq from reacquiring biological warfare capability and must take steps to develop a multidisciplinary approach to limiting future development of weapons of mass destruction.

Aflatoxins↗
PubMed1977

Intraocular lenses in children.

The intraocular lens offers an experimental alternative to be considered for the visual rehabilitation of children with traumatic or unilateral infantile cataracts. The disadvantages of aphakic spectacles or contact lenses and amblyopia have committed many of these eyes to the status of visual cripples. In this series of 41 patients with a maximum of 24 months follow-up, it has been concluded that an IOL may be successfully implanted. I wish to reemphasize that vitreous involvement does not preclude IOL implantation providing all the vitreous is removed from the anterior chamber by the conclusion of the operation. Discissions of secondary membranes should be performed if there is any doubt as to the clarity of the membrane. All patients should be repeatedly refracted and the over-refraction prescribed to assure that the child is obtaining the best possible form vision to the aphakic eye. Bifocals are encouraged for near work. Vigorous occlusion therapy is undertaken in all patients exhibiting signs of amblyopia.

Adolescent↗
PubMed1997

Understanding the devastation of AIDS.

A patient admitted to your unit this morning presents a dauntingly complex clinical picture. Maria DeJesus, 34 years old, has HIV infection, which progressed to AIDS last year with an episode of Pneumocystis carinii pneumonia. She's also experienced recurrent vaginal and esophageal candidiasis and cryptococcal meningitis, and her more recent history includes peripheral neuropathy, causing pain and numbness, as well as cognitive and motor function problems. Her admission was prompted by diarrhea that has persisted despite outpatient treatment. To provide the best care for patients like Ms. DeJesus, you need to understand HIV infection and the diseases associated with it. Yet that's a challenging task, given that the possible manifestations of advanced infection are so many and varied. Though your approach to care is holistic, you may find it helpful to consider the numerous facets of the patient's illness individually. In the following pages, we'll examine how HIV enters the body, infects immune cells, and eventually cripples the immune system. We'll look at some of the more common opportunistic infections preying on people with HIV. And we'll explore the less well-charted territory of complications attributed to HIV infection of the central and peripheral nervous systems.

AIDS-Related Opportunistic Infections↗
PubMedDate not supplied

The natural history of thoracic aortic aneurysm disease: an overview.

Relatively little is known of the natural history of thoracic aortic aneurysms (TAA). The limited data available suggests that survival is at best equivalent to that observed for abdominal aortic aneurysm (AAA), and probably significantly worse. Patients with an AAA > 6 cm diameter have a 5-year survival of 10%, with a cumulative risk of rupture over 10 years of 43%. Rupture is also responsible for death in 25% of patients with 4-7 cm AAA. Natural history studies of TAA report a 1- and 5-year survival of 39%-52% and 13%-19%, respectively, but many studies include data on acute type A dissection. Although most mortality in patients with TAA is related to aneurysm rupture, data on the relationship between aneurysm size and rupture risk remains scarce. TAA is a highly lethal condition warranting consideration of elective, prophylactic surgical repair. However, the timing of surgery is often a difficult clinical decision, particularly in asymptomatic patients or those with comorbid conditions. Surgery for TAA carries a significant mortality and potentially permanently crippling morbidity. A recommendation of surgery represents a balance, weighing estimates of TAA natural history and rupture risk against operative mortality and complication rate, while carefully considering the impact of important comorbid conditions, e.g., ischemic heart disease, obstructive pulmonary disease, and renal dysfunction. When to intervene is a critical question facing cardiovascular surgeons and is based upon an assessment of the risk of rupture. This risk is related to the site, aetiology, size, and expansion rate of the aneurysm.

Aortic Dissection↗
PubMed1997

[Late diabetic sequelae].

Diabetic patients are exposed to higher risk of morbidity and mortality. However, it is difficult to define this in advance and to predict the degree of inability for work. The risk is depending on type of diabetes, age of manifestation, age of the patient course and duration of the disease and mainly from glycemic control. Educational programs may markedly ameliorate the overall situation and decrease of risk of late complications which may threat kidney, eyes, nerves and the cardiovascular system. However, it is an erroneus notion that most diabetics may be crippled by complications of their disease which may result in unwarranted bias against them in both work and leisure activities. Most diabetics may undertake any occupation or hobby, of course with some exceptions when hypoglycemia due to insulin or hypoglycemic agents represents risk for themselves and other persons. Those patients may not serve as pilots and cannot hold public service vehicle driving licences. They should not take over the supervision in power-stations etc. Ordinary driving licences can be held by diabetic patients if on insulin or not, provided that they are otherwise physically fit and do not suffer from blackouts. From many studies it is known that the rate of accidents is not higher with respect to diabetic patients than in the normal population. Life assurance premiums are often raised by amounts which depend on the result of a medical examination but it is very important that the judgement is not made on the basis of a single checkup at a given time. To get information about the presence or development of late complications which have a very broad spectrum it is necessary to have insight into the course of the metabolic disorder and the tendency of worsening or amelioration.

Cause of Death↗
PubMed1997

Anterior ischemic optic neuropathy.

Anterior ischemic optic neuropathy (AION), one of the most prevalent and visually crippling diseases in the middle-aged and elderly, potentially bilateral, is due to acute ischemia of the optic nerve head. For a logical understanding of its pathogenesis, underlying causes, clinical features, and management, it is essential to comprehend the basic scientific issues involved; these are discussed briefly in this paper. Clinically, AION is of two types: (1) arteritic AION (due to giant cell arteritis) and (2) nonarteritic AION (due to other causes). Arteritic AION is an ophthalmic emergency because of its potential of causing rapid, bilateral complete blindness which is almost always preventable if treated immediately with large doses of systemic corticosteroids. Clinical parameters which help to differentiate the two type of AION, and their management are discussed.

Arteritis↗
PubMed1997

Specificity in structure-based drug design: identification of a novel, selective inhibitor of Pneumocystis carinii dihydrofolate reductase.

Specificity is an important aspect of structure-based drug design. Distinguishing between related targets in different organisms is often the key to therapeutic success. Pneumocystis carinii is a fungal opportunist which causes a crippling pneumonia in immunocompromised individuals. We report the identification of novel inhibitors of P. carinii dihydrofolate reductase (DHFR) that are selective versus inhibition of human DHFR using computational molecular docking techniques. The Fine Chemicals Directory, a database of commercially available compounds, was screened with the DOCK program suite to produce a list of potential P. carinii DHFR inhibitors. We then used a postdocking refinement directed at discerning subtle structural and chemical features that might reflect species specificity. Of 40 compounds predicted to exhibit anti-Pneumocystis DHFR activity, each of novel chemical framework, 13 (33%) show IC50 values better than 150 microM in an enzyme assay. These inhibitors were further assayed against human DHFR: 10 of the 13 (77%) bind preferentially to the fungal enzyme. The most potent compound identified is a 7 microM inhibitor of P. carinii DHFR with 25-fold selectivity. The ability of molecular docking methods to locate selective inhibitors reinforces our view of structure-based drug discovery as a valuable strategy, not only for identifying lead compounds, but also for addressing receptor specificity.

Antifungal Agents↗
PubMedDate not supplied

Heparin induced thrombocytopenia. Experiences in 12 heart surgery patients.

A heparin induced thrombocytopenia Type II (HIT) is a dangerous complication of heparin therapy. Bleeding, but above all serious thromboembolic complications, which may result in crippling disabilities or even death, can develop. Twelve heart surgery patients who were diagnosed with a HIT Type II are reported. Seven of the patients were diagnosed post operatively, the other five pre-operatively. Two of these patients underwent heart surgery with r-Hirudin (Behringwerke AG, Marburg, Germany) on cardiopulmonary bypass and two on Orgaran (AKZO Organon, the Netherlands). Of the seven post operative HIT patients, four had had a bypass operation and each had received a mitral or aortic valve replacement. Another patient had received an artificial biventricular support system (Berlin Heart) and was diagnosed with HIT Type II post operatively. Because of his special condition, this patient underwent anticoagulation with Orgaran and heart transplantation with Orgaran on a heart lung machine. Upon suspicion of HIT Type II, heparin therapy was immediately halted and an alternative treatment of Orgaran or r-Hirudin was begun. One patient encountered bleeding of a gastric ulcer on Orgaran therapy. Heart surgery patients, especially patients with an artificial support system, are potentially lethally threatened by serious thromboembolic complications accompanying HIT Type II. Therefore, these patients must be diagnosed as early as possible. Orgaran along with r-Hirudin are effective heparin substitutes in patients with HIT Type II. These medications can be widely administered to heart surgery patients pre-, intra-, and post operatively without complication.

Adult↗
PubMed1976

Hypophosphataemic osteomalacia and Fanconi syndrome of adult onset with dominant inheritance. Possible relationship with diabetes mellitus.

Adult-onset osteomalacia with multiple renal tubular defects and generalized aminoaciduria is uncommon, and where familial it is characteristically an autosomal recessive disorder. This paper describes a kindred in which the syndrome has appeared in four successive generations, apparently inherited in a dominant manner, and possibly associated with diabetes mellitus. The proposita had hypophosphataemia, renal glycosuria, proteinuria and generalized aminoaciduria, and at the age of 22 developed symptoms of osteomalacia which responded to treatment with oral phosphate. Her father had been similarly affected: renal glycosuria was first noted when he was 24, and 12 years later he developed diabetes mellitus from which he died. One sister, aged 31, has renal glycosuria, aminoaciduria and hypophosphataemia without bone disease. In the three preceding generations at least seven other individuals had crippling bone disease and profound muscle weakness of early adult onset; in four, preterminal polydipsia was recorded, and others had renal glycosuria or diabetes mellitus. Three of the five children in the latest generation have slight proteinuria but not other detectable abnormality. The possible association between these renal tubular defects and diabetes mellitus is discussed.

Adolescent↗
PubMed1997

Rheumatoid arthritis--current trends in management.

RA is a chronic progressive polyarthritis associated with substantial disability. The current treatment protocols envisage early use of DMARDs before erosions develop. Patient education and increased physician awareness are the need of the day in order to minimize the morbidity and mortality associated with this crippling disease.

Activities of Daily Living↗
PubMed1997

Spine surgery in geriatric patients.

AIM: Many elderly patients are crippled by degenerative spine conditions. Operative treatment is often not offered due to fear of complications and consideration of life span. The objective of this study was to look at the diagnosis, surgical results and post-operative complications of elderly patients who underwent spinal surgery. METHODS: A cohort of 44 patients, 65 years and older, who had surgery in Tan Tock Seng Hospital from January 1990-August 1995 were reviewed. Twenty-five of them had spinal stenosis, II had tumour and 9 had traumatic fracture/dislocation/subluxation. There were 3 patients each with disc herniation, infection and spondylolisthesis. Nine patients had more than one diagnosis. All patients were investigated post-operatively. The data was entered into a computer-coded protocol. The diagnosis was determined intraoperatively. Type of surgery, co-morbid conditions and results were looked into. Patient's opinion on relief symptoms was graded on a 5-point scale. Functional improvement was tabulated as the patient's ambulatory status. RESULTS: The analysis of results was divided into two groups, patients with tumour and those without tumour. Twenty-seven of the 33 patients without tumour were alive at follow-up. Twenty-six of these patients had improvement of symptoms and 18 of 27 had improved functional status post-operatively. In the group with tumours, 2 had worsening symptoms and 3 had decreased function. CONCLUSION: Surgical intervention should be a treatment option in elderly patients with spinal disease.

Aged↗
PubMed1997

Molecular biology of Hodgkin's disease.

The mist surrounding the origin and genesis of HRS cells of classical HD is beginning to dissipate. Molecular biological studies of classical HD at the single cell level strongly suggest that the HRS cells in the majority of cases represent a monoclonal outgrowth of late germinal centre B cells that have lost their capacity to express IG through crippling mutations introduced during the germinal centre reaction. Because of the expression of T cell antigens and/or cytotoxic molecules, the HRS cells of a minority of classical HD cases appear to originate from T cells. Under physiological conditions, B cells that are unable to express IG are eliminated by apoptosis. In most B cell derived classical HD cases, the HRS cells have lost their IG gene coding capacity through mutation and should therefore die of apoptosis. Since this usually does not happen, blockade of the apoptotic pathway may be a major event in the pathogenesis of B cell related classical HD. It is tempting to assume that viruses such as EBV, as well as regulator genes that normally monitor the human genome for damaged DNA, such as TP53, might be involved in the postulated hindrance of the apoptotic pathway, leading to the genesis of classical HRS cells.

Chromosome Aberrations↗
PubMed1998

[Consensus antithrombotic prophylaxis of vascular incidents in patients with manifest atherosclerotic vascular diseases. Central Guidance Organization for Peer Review].

The consensus on antithrombotic prophylaxis of vascular incidents in patients with manifest atherosclerotic vasculopathy was preceded by a systematic classification of results from relevant articles according to 'evidential value': from randomized prospective trials of sufficient quality and size, via less adequate or non-randomized trials to the current opinion in the Netherlands. The principal advice was to prescribe antithrombotic prophylaxis, mostly acetylsalicylic acid, for patients with manifest atherosclerotic vasculopathy (in head, heart and (or) legs). With regard to the question what drug should be preferred for patients with intermittent claudication, no consensus could be reached for lack of adequate research. Acetylsalicylic acid is not more effective in higher than in lower doses, but in higher doses it has more side effects; therefore lower doses are preferred: 80-100 mg per day, and for neurological indications, 30 mg or more per day. Use of coumarin derivates is only to be preferred in patients with atrial fibrillation who have suffered a TIA or a non-crippling cerebral infarction, in patients with atrial fibrillation and a cardiac disorder such as large myocardial infarction or a left ventricular aneurysm, and in patients who have undergone a cardiac valve operation. Since the proportion of pros and cons of antithrombotic prophylaxis may change during a patient's life, the indication should be reconsidered periodically.

Anticoagulants↗
PubMed1976

Psychotherapists' passivity--a major training problem.

A major problem encountered in the early psychotherapy training of psychiatric residents, psychologists, and social workers is the tendency for the student to take an inappropriately passive and silent role. Rather than actively engage patients in a therapeutic alliance, beginning students have the tendency to remain withdrawn and inarticulate. This often reaches extreme proportions and may later significantly block treatment progress. Clinical vignettes are presented to show the range and variety of hyperpassive behavior in psychotherapy training and the potential crippling and destructive effects on the treatment process. This is not to imply that there is no danger in excess activity on the part of the therapist. Indeed, not all silence need be destructive. However, detachment, withdrawal, and excess silence--attitudes often fostered by our training programs--can be markedly destructive to both patients and treatment. Psychodynamic factors causing this situation are reviewed. A variety of methods and strategies are recommended for dealing with it. If the supervisor remains alert, the problem can be significantly resolved before it interferes with treatment. In this way, the student will be helped to overcome one of the major ealry hurdles of training.

Adult↗
PubMed1995

Ridge preservation: the new buzzword in dentistry.

The viability of Ridge Preservation as achieved by practicing Advanced Extraction Therapy (AET) and Replacement Therapy (R.T.), will impact the future practice of Dentistry. With the availability of clinically proven materials such as implants (titanium) and synthetic bone substitutes (Bioplant HTR), a practical solution exists to solve a very old clinical problem. Treatment modalities are available today making the atrophic jaw-bone a malady of the past. Imagine no more "dental cripples," and no more inadequate bone situations for implant placements. Ridge Preservation and Replacement Therapy should be practiced regularly: "when we take something out, we should put something back." Our practices will grow. Our patients will thank us.

Alveolar Bone Loss↗
PubMed1998

Animal models of heterotopic ossification.

Heterotopic ossification is often a severe clinical complication of joint arthroplasty, neurologic trauma, and muscle injury. In rare genetic disorders, such as fibrodysplasia ossificans progressiva, heterotopic ossification can be crippling and often leads to premature death. Reliable animal models of heterotopic ossifications that mimic pathologies seen in man would be invaluable for the development of new treatments to combat heterotopic ossification. Various methods used to induce heterotopic ossification in animals including the use of bone morphogenetic proteins, urinary tract epithelia, and transformed cell lines are described. Genetic animal models of heterotopic ossification and various miscellaneous examples of heterotopic ossification in animals are described. Finally, the use of transgenic mice to manipulate bone morphogenetic protein expression is discussed as a possible future animal model of heterotopic ossification.

Animals↗