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PubMedDate not supplied

Ulcerative colitis: analyses of 116 cases (do extraintestinal manifestations effect the time to catch remission?).

BACKGROUND/AIMS: Evaluation of clinical, demographic and epidemiologic features of ulcerative colitis and therapy response of these patients. METHODOLOGY: Retrospectively, 116 patients (64.7% female) were enrolled in this study. Mean age and mean follow-up period were 36+/-16, 5+/-2 years, respectively. RESULTS: The most common anatomic involvement was pancolitis (60.3%) and the others were as follows: left side 25%, rectum 13.8% and ileum (backwash ileitis) 0.9%. Extraintestinal manifestations were observed in 42.2% of patients (sacroiliitis 12%, primary sclerosing cholangitis 7.6%, pyoderma gangrenosum 2.4%, peripheral arthropathy 1.6%, autoimmune hepatitis 1.6%, steatosis 12.9%, gallstone 0.8%, perianal fistulas 0.8%, sagittal sinus thrombosis 0.8%, psoriasis 0.8%). Multiple extraintestinal manifestations were observed (primary sclerosing cholangitis + pyoderma gangrenosum) in 2 patients. Colonic perforation due to toxic megacolon was observed in only one patient during follow-up period. The mean period for remission was 3.7 months in 72% of patients with pancolitis by the treatment of 5-aminosalicylic acid (5-ASA) (2-3 gr/day) + methylprednisolone (1 mg/kg/day) +/- (for maintenance of remission) azathioprine (AZT) (1.5-2 mg/kg/day); 3.7 months in 72% of left-sided colitis by 5-ASA +/- corticosteroid enemas +/- methylprednisolone (1 mg/kg/day) +/- (for maintenance of remission) AZT (1.5-2 mg/kg/day) and 3.7 months in 62.5% of patients with distal colitis by 5-ASA (p.o. +/- enema) +/- corticosteroid enemas. Colectomy was performed on 7 patients refractory to these treatments. Six patients (4 of them had pancolitis) were treated with cyclosporine (Cys) (4 mg/kg/day, p.o.). Only one patient, a non-responder to Cys therapy, had colectomy. The mean remission time was 4.7 months in 80.6% of patients with extraintestinal involvement and 3.2 months in 71.2% of patients without extraintestinal involvement (P=0.002). CONCLUSIONS: Medical therapy was generally enough for the treatment. Cys and/or surgery can be another choice for the patients that do not respond to the medical therapy. Extraintestinal manifestations do not change the remission rate, but prolong the time to catch remission.

Adult↗
PubMed2004

[Acute otitis media and its life-threatening complications].

Acute otitis media is a widespread disease affecting all ages. The introduction of antibiotics has led to a reduction in the incidence of complications from approx. 17% to 1%. Nevertheless, life-threatening complications still occur. The present paper describes the course and treatment of mastoiditis, petrositis and sepsis, as well as intracranial complications, i.e. meningitis, sigmoid sinus thrombosis, extradural abscess, subdural empyema, brain abscess and otitic hydrocephalus. The importance of antibiotic treatment for acute otitis media and the need to assess treatment outcomes are emphasised.

Acute Disease↗
PubMed1992

High incidence of disseminated intravascular coagulation during remission induction of adult patients with acute lymphoblastic leukemia.

We determined the incidence and complications of disseminated intravascular coagulation (DIC) at presentation and during remission induction of previously untreated adults with acute lymphoblastic leukemia (ALL) or de novo Philadelphia chromosome-positive ALL (PCALL) seen at Memorial Hospital between January 1, 1978 and December 31, 1989. DIC was diagnosed in the presence of (1) low fibrinogen (less than or equal to 160 mg/dL), (2) prolonged prothrombin time (PT) and falling fibrinogen, or (3) prolonged PT and positive fibrin split products (FSP). L-Asparaginase was not used during remission induction. Among adequately screened patients with ALL, DIC was detected in 7 of 58 (12%) before initiation of chemotherapy and in 35 of 45 (78%) during remission induction. DIC was not simply the result of infection because clinical and laboratory signs of infection were absent in 16 patients, whereas only 2 of the 22 febrile patients with DIC had positive cultures. Among the 38 patients with DIC at presentation or during remission induction, serious complications were seen in 13 in temporal association with DIC (pulmonary embolus in one, sagittal sinus thrombosis in three, and serious hemorrhage in nine) and were major factors in the deaths of three patients. Among the 10 patients with thorough screening but no evidence of DIC there was only one hemorrhage during the same time interval. In patients with PCALL, DIC was detected in 9% at presentation and in 80% during remission induction. We conclude that DIC is rare at presentation but common during remission induction of adult ALL and PCALL and may be associated with significant thrombotic and hemorrhagic complications. We suggest daily screening for DIC during the first 14 days of remission induction. The treatment of DIC in ALL and PCALL should be a subject of future clinical studies.

Adult↗
PubMed1992

Periorbital and orbital infections in children.

Bacterial infections of the periorbital and orbital tissues range in severity from minor to life-threatening. Preseptal (periorbital) cellulitis is more common than orbital cellulitis and occurs quite frequently in children. A history of antecedent trauma or upper respiratory tract infection is present in more than half of all cases. Evaluation by computed tomography scans is an indispensable part of the diagnostic procedure. All cultures should be obtained before institution of antibiotic therapy. Initial therapy should begin with administration of broad-spectrum antibiotics with adjustments made in response to positive culture results. Response to antibiotics is usually prompt and the incidence of complications is low. If clinical improvement is slow, surgery should be performed early in the course of the disease to minimize the potential for significant complications such as cavernous sinus thrombosis.

Bacterial Infections↗
PubMedDate not supplied

Frequency of intra cranial complications in Chronic Otitis Media.

BACKGROUND: Chronic Otitis Media can lead to intracranial complications, which were more common in pre-antibiotic era as compared to the present antibiotic era. Patients of Chronic Otitis Media with intracranial complications usually present very late due to ignorance and lack of primary health care. The aim of this study was to investigate, the frequency, mortality and morbidity of intracranial complications of chronic otitis media admitted in Ear Nose and Throat Unit of Lady Reading Hospital Peshawar. METHODS: This study was conducted in Government Lady Reading Hospital Peshawar for a period of two years from October 2001 to October 2003. All the patients diagnosed as intracranial complications of chronic otitis media were included in the study. RESULT: The total number of patients reporting with intracranial complication due to chronic Otitis media (Unsafe ear) was 20. Meningitis and brain abscess were present in 8 cases each (40%). In 3 cases (15%) extradural abscess was found while 1 (5%) had lateral sinus thrombosis. CONCLUSION: Chronic Otitis media is a common disease in our part of the world.

Adolescent↗
PubMed2006

Guidelines for prevention of stroke in patients with ischemic stroke or transient ischemic attack: a statement for healthcare professionals from the American Heart Association/American Stroke Association Council on Stroke: co-sponsored by the Council on Cardiovascular Radiology and Intervention: the American Academy of Neurology affirms the value of this guideline.

The aim of this new statement is to provide comprehensive and timely evidence-based recommendations on the prevention of ischemic stroke among survivors of ischemic stroke or transient ischemic attack. Evidence-based recommendations are included for the control of risk factors, interventional approaches for atherosclerotic disease, antithrombotic treatments for cardioembolism, and the use of antiplatelet agents for noncardioembolic stroke. Further recommendations are provided for the prevention of recurrent stroke in a variety of other specific circumstances, including arterial dissections; patent foramen ovale; hyperhomocysteinemia; hypercoagulable states; sickle cell disease; cerebral venous sinus thrombosis; stroke among women, particularly with regard to pregnancy and the use of postmenopausal hormones; the use of anticoagulation after cerebral hemorrhage; and special approaches for the implementation of guidelines and their use in high-risk populations.

American Heart Association↗
PubMed2005

Nonopportunistic neurologic manifestations of the human immunodeficiency virus: an Indian study.

CONTEXT: HIV-1 is a neurotropic virus. In a resource-limited country such as India, large populations of affected patients now have access to adequate chemoprophylaxis for opportunistic infections (OIs), allowing them to live longer. Unfortunately the poor availability of highly active antiretroviral therapy (HAART) has allowed viral replication to proceed unchecked. This has resulted in an increase in the debilitating neurologic manifestations directly mediated by the virus. OBJECTIVE: The main objective of this study was to identify and describe in detail the direct neurologic manifestations of HIV-1 in antiretroviral treatment (ART)-naive, HIV-infected patients (excluding the neurologic manifestations produced by opportunistic pathogens). DESIGN: Three hundred successive cases of HIV-1 infected, ART-naive patients with neurologic manifestations were studied over a 3-year period. Each case was studied in detail to identify and then exclude manifestations due to opportunistic pathogens. The remaining cases were then analyzed specially in regard to their occurrence and the degree of immune suppression (CD4+ cell counts). SETTINGS AND PATIENTS: The study was carried out in an apex, tertiary, referral care center for HIV/AIDS in India. All patients were admitted for a detailed analysis. No interventions were carried out, as this was an observational study. RESULTS: Of the 300 cases, 67 (22.3%) had neurologic manifestations due to the direct effects of HIV-1. The HIV infection involved the neuroaxis at all levels. The distribution of cases showed that the region most commonly involved was the brain (50.7%). The manifestations included stroke syndromes (29.8%), demyelinating illnesses (5.9%), AIDS dementia complex (5.9%), and venous sinus thrombosis (4.4%). The other manifestations seen were peripheral neuropathies (35.8% of cases), spinal cord pathologies (5.9% of cases), radiculopathies (4.4% of cases), and a single case of myopathy. The onset of occurrence of these diseases and their progression were then correlated with the CD4+ cell counts. CONCLUSIONS: HIV infection is responsible for a large number of nonopportunistic neurologic manifestations that occur across a large immune spectrum. During the early course of the disease, the polyclonal hypergammaglobulinemia induced by the virus results in demyelinating diseases of the central- and peripheral nervous systems (CNS and PNS). As the HIV infection progresses, the direct toxic effects of the virus unfold, directly damaging the CNS and PNS, resulting in protean clinical manifestations.

AIDS-Related Opportunistic Infections↗
PubMed2005

Homocystinuria in Thai patient--Phramongkutklao Hospital experience.

Homocystinuria is a rare autosomal recessive disorder of amino acid metabolism. Classic (type I) homocystinuria is the most common type and occurs as a consequence of a deficiency of cystathionine-b-synthase, producing increased blood and urine homocysteine. The authors report a 15-year-old Thai male who presented with generalized tonic-clonic seizures from superior sagittal sinus thrombosis, bilateral downward subluxation of ocular lenses (ectopia lentis), Marfanoid habitus, osteoporosis, attention deficit and hyperactivity disorder. Urine metabolic screening was positive for cyanide nitroprusside test. Levels of plasma homocysteine and methionine were elevated. The clinical and laboratory findings in this case are consistent with the diagnosis of "type I" or "classical homocystinuria". The treatment was started with a low methionine diet, vitamin B6 or pyridoxine, folic acid, anticonvulsants, antithrombotic treatment and calcium supplementation. Genetic counseling was provided to the family with the recurrent risk of 25%. Definite diagnosis by enzyme assay or mutation analysis and also prenatal diagnosis are not established in Thailand.

Adolescent↗
PubMed2006

Multiple cranial nerve palsies associated with type 2 diabetes mellitus.

Although isolated cranial nerve palsies are common in patients with diabetes mellitus, multiple simultaneous cranial neuropathies are rare. We report a 48-year-old man, a known case of diabetes mellitus, who presented with facial palsy, foot drop and painful ophthalmoplegia of the left eye. The initial differential diagnosis included diabetic polyneuropathy, septic cavernous sinus thrombosis, mucormycosis and the Tolosa Hunt syndrome. Magnetic resonance (MR) imaging findings were consistent with those of the Tolosa Hunt syndrome. The patient had a remarkable complete resolution of his ophthalmoplegia after four weeks of steroid treatment, with repeat MR imaging showing resolution of the initial changes.

Comorbidity↗
PubMed2006

[Stroke: causes and classification].

Cerebrovascular disease is caused by ischaemic stroke, intracerebral haemorrhage, subarachnoidal haemorrhage or cerebral vein and sinus thrombosis. Approximately 80% of all cerebrovascular accidents are caused by ischaemic stroke, whereas 20% are due to primary haemorrhage. This article summarizes the typical causes of each of the four main groups of cerebrovascular disease and points out clinical differences. Special attention is given to transitory ischemic attacks since new reports underline the necessity of early diagnostic and therapeutic intervention. Useful diagnostic and clinical scales are presented and discussed.

Brain Ischemia↗
PubMedDate not supplied

[Characteristics of the clinical course and treatment of epitympanitis with cholesteatoma in children].

A specific form of chronic epitympanitis has been identified in children. This pathology includes tympanic membrane perforation above he lateral process of the malleus and is termed cholesteatomic epitympanitis . This is because it is accompanied by epidermis growth across the perforation into Prussak's space. This form of epitympanitis occurred in 40 (75%) children out of 53 cases operated during 10 years. It is underlined that this pathology can hardly be diagnosed since it often develops together with sclerosis of mastoid cells. These children had frequent recurrent otitis media. An immediate cause was Eustachian tube closure, often with adenoid vegetations. Adenotomy was performed in 17 (42.5%) children. All patients underwent radical surgery; 16 showed large cholesteatoma, 5 developed intracranial complications, 2 of whom had sinus thrombosis and sepsis. One of operative findings was delineation of the attic from the mesotympanum and the tympanic ostium of the Eustachian tube.

Child↗
PubMedDate not supplied

Neurologic involvement in Behçet disease: imaging findings in 16 patients.

Behçet disease is a rare multisystem immune-related vasculitis that is prevalent in Japan, the Middle East, and many Mediterranean countries. In our study population of 36 patients with Behçet disease, 16 (44%) had CNS involvement. CT was noncontributory, except in a single patient with dural sinus thrombosis. MR imaging in nine patients showed foci of high signal intensity on T2-weighted images within the brainstem, the basal ganglia, and the cerebral hemispheres in that order of frequency. Unlike the plaques associated with multiple sclerosis, Behçet lesions show no predilection for the periventricular regions.

Adolescent↗
PubMed1991

CNS complications of ear, nose and throat infections: an analysis of 50 consecutive cases.

Sixty-four diverse central nervous system (CNS) complications were noted in a series of 50 patients initially suffering from an otorhinological infection. Thirty-five patients (70%) were in pediatric age groups (1-15 years). Twelve patients (24%) had more than one complication. Mortality rates were 16% in patients with one CNS complication and 25% in patients with multiple complications. Overall mortality rate was 18%. Leptomeningitis was the most common intracranial complication (42%) occurring, mainly in pediatric patients. Lateral sinus thrombosis (LST) was accompanied with other intracranial abnormalities in 72% of the cases. Brain abscess as an initial or concomitant complication was associated with the highest mortality rates (44%). Three of these fatal cases had multiple brain abscess. The rarity of intracranial suppurations secondary to ear and nose infections and the masking effect of the antibiotics bring difficulties in the early detection of CNS complications. Although the modern imaging techniques contribute to the recognition and localization of the intracranial pathology, the clinical investigation is still of paramount importance in detection of the original infection in the pneumatic spaces of the upper respiratory tract.

Adolescent↗
PubMed1991

Magnetic resonance angiography of the intracranial vasculature.

Preliminary experience has shown that MRA can provide useful clinical information that complements the more traditional SE brain evaluation of patients with cerebrovascular disease. MRA is particularly appealing in that it provides a relatively rapid, noninvasive alternative to the existing vascular imaging modalities and the capability to evaluate the brain parenchyma directly. This can often be done without repositioning the patient or significantly prolonging the examination time. MRA sequences have been applied in the evaluation of patients with intracranial aneurysms, vascular malformations, vasoocclusive disease, neoplasms, and dural sinus thrombosis. The MRA study design and acquisition parameters are crucial and need to be optimized to maximize sensitivity and specificity of the examination based on the individual clinical presentation. The results of the SE and MRA studies should be evaluated together to obtain a definitive diagnosis or to determine whether conventional angiography is needed. As with any other diagnostic procedure, it is important to recognize the strengths and limitations of these techniques. Despite its advantages, MRA will not replace conventional catheter angiography in the near future. Rather, it will complement existing indications for conventional MR studies. Spatial resolution and intravascular signal loss due to rapid, complex flow continue to be the most limiting factors in intracranial MRA imaging. Significant improvements in these areas are currently being realized.

Brain↗
PubMed1990

The clinical spectrum of staphylococcal bacteraemia: a review of 101 Melanesian patients from Papua New Guinea.

The clinical features of 101 Melanesian patients with Staphylococcus aureus bacteraemia observed during two 2-year periods (1977-1979 and 1985-1987) in a university teaching hospital in Papua New Guinea are reviewed. The age of the patients ranged from 12 to 70 years. There were 69 males and 32 females. Diabetes mellitus, found in 15 patients, was the most common predisposing factor. Most of the patients (87%) had community-acquired infection. Soft-tissue infection, pneumonia, arthritis, osteomyelitis, intravenous-site thrombophlebitis, cerebral abscess, endocarditis and cavernous sinus thrombosis were among the clinical entities observed. Soft tissues and lungs were the most common sites of primary and secondary foci of infection, respectively. All but 1 of the 101 blood isolates were resistant to penicillin G and none was resistant to methicillin. The overall case fatality rate was 24%. These data demonstrate that staphylococcal bacteraemia in adult Papua New Guineans is mostly community acquired and has a high mortality. Skin and soft tissues are the major primary foci of infection leading to staphylococcal bacteraemia.

Adolescent↗
PubMed1990

Dural arteriovenous fistulas involving the inferior petrosal sinus: angiographic findings in six patients.

We report the angiographic findings from six patients with intracranial dural arteriovenous fistulas of the inferior petrosal sinus and describe the clinical presentation, vascular anatomy, and embolization techniques used in the treatment of this disorder. Dural arteriovenous fistulas at this site are rare; of 105 patients diagnosed with this abnormality, only six had lesions involving the inferior petrosal sinus. The patients included three men and three women, ranging in age from 41 to 75 years. Patients presented with bruit, proptosis, abducens palsy, or loss of vision, and symptoms were present for up to 1 year prior to diagnosis. These presentations were similar to cavernous sinus arteriovenous fistulas. The arterial supply in all cases was from branches of the external carotid artery and in three cases from the meningohypophyseal trunk of the internal carotid artery. Venous drainage in four patients was via the cavernous sinus to the superior ophthalmic vein. The remaining two patients had drainage primarily to the jugular bulb. In four patients treatment was performed by introducing wire coils into the fistula from the transvenous route. This approach could be used even though the inferior petrosal sinus was thrombosed. One patient, treated early in the series, had only transarterial embolization with both liquid adhesives and particulate embolic agents. One patient had an asymptomatic fistula that was not treated. All patients were cured, as evidenced both angiographically and clinically during the follow-up period. Three patients experienced complications from angiography and treatment: two had transverse sinus thrombosis and one had a transient ischemic attack.

Adult↗
PubMedDate not supplied

[Clinical and therapeutic aspects of headache of vascular origin in children].

The authors present the problem of vascular headache at children: headaches caused by high blood pressure, aneurysm and other intracranial vascular malformations of the intracranial venous sinuses thrombosis (here, the determining factors are the infectious and inflammatory factors). Here are mentioned, one by one, the kinds of headaches, following the a/m classifications, with the clinical particularities and the therapeutical indications. There are reviewed a series of other causes of the headaches at children: headache caused by muscular contractions, the post traumatic headache, headache caused by cerebral tumours, by nasosinusal causes, ocular headache, headache caused by infections or metabolic diseases, and the psychogenic headache.

Child↗
PubMed1989

[Malignant lymphoma presenting with bilateral orbital apex syndrome].

This is the first report of bilateral orbital apex syndrome caused by malignant lymphoma. A 73-year-old man suffered from right forehead pain, diplopia and right numb cheek. Thereafter progressed bilateral visual disturbance rapidly, and soon he became blind. Cavernous sinus thrombosis was suspected clinically, but histological study of the biopsied specimen from the nasopharynx revealed malignant lymphoma (non-Hodgkin, diffuse, large cell type) (LSG). The patient died 5 months after the onset of his illness. Autopsy revealed lymphoma cell invasion and necrosis in parasellar region, bilateral optic nerves, nasopharynx, and left posterior root of L3. There was no lymphoma cell in the liver, spleen, or gastrointestinal tract. The nasopharynx was suspected to be the primary site of the tumor. In bilateral orbital apex syndrome, malignant lymphoma should be taken into consideration. Remission can be expected if treatment is started in early stage.

Aged↗