Current Symptons News Results

[Endoscopic argon plasma thermo-coagulation of Barrett's esophagus using different powers: histopathological and post procedure symptons analysis]

Rev Col Bras Cir. 2009 Apr; 36(2): 110-7
Dotti VP, Baretta GA, Yoshii SO, Ivano FH, Ribeiro HD, Matias JE

OBJECTIVE: To establish the ideal power to be employed in order to get the effective ablation and the lowest rate of symptoms at argon plasma thermocoagulation in Barrett's esophagus (BE). METHODS: Twenty-eight asymptomatic patients with BE, were randomly divided in two groups of different ablation powers, 50W or 70W. After endoscopic ablation and biopsies from the treated area for histological analyses, symptoms were evaluated through a questionnaire answered by phone. RESULTS: Thirteen patients without specialized columnar metaplasia were excluded and the remaining fifteen patients, seven men (46,7%) and eight women (53,3%), with an average age of 53 years +10,4, composed the two groups: 10 patients at the 70W power and 5 at the 50W power group. There was no significant difference between the groups regarding age, BE extent, percentage of coagulated esophageal circumference and the duration of symptoms. Pain was the most important symptom, with a mean duration of 10,3 + 9,7 days. When power was compared to symptoms, although not statistically significant, a moderate negative correlation was noted. Endoscopic biopsies showed ablation restricted to the mucosa's superficial layer in 40% of the cases in the lower power group, and only 10% in the higher power group, although deeper layers of the mucosa were compromised. There were no statistical significant differences when comparing the different powers to the penetration through the mucosa's layers and the symptoms. CONCLUSION: There are evidences that the 70W potency argon plasma coagulation for BE leads to a lower incidence of residual specialized columnar metaplasia under the new scamous epithelium.

Gas exchange, antioxidants and foliar injuries in saplings of a tropical woody species exposed to ozone.

Ecotoxicol Environ Saf. 2010 May; 73(4): 685-91
Pina JM, Moraes RM

Ozone (O(3)) reaches phytotoxical concentrations in the tropics, but the sensitivity of tropical plant species to O(3) remains unknown. Visible foliar injuries, carbon assimilation (A(sat)), stomatal conductance, superoxide dismutase enzyme (SOD) activity and ascorbic acid concentration (AA) were evaluated in different-aged leaves of Psidium guajava 'Paluma' saplings. We hypothesized that the old leaves are less capable of combating the stress induced by O(3) and hence exhibit more severe leaf injuries. Three O(3) exposure experiments were performed with 'Paluma' saplings in sites with high O(3) concentration and also under filtered air conditions. The exposure experiments corresponding to the seasons spring/2006, summer and autumn/2007. The decrease of A(sat) was greater in old leaves of saplings exposed to O(3), except in the second experiment, when the AA concentrations were more pronounced than in the other experiments. In second experiment, O(3) uptake was similar to that of the first experiment, but the injuries were less severe, probably due to the high AA concentrations. It was not possible to identify a pattern of superoxide dismutase enzyme (SOD) activity due to the high variability in the results from O(3) exposed and reference saplings. O(3) uptake/A(sat) was higher in leaves exhibiting greater injury, suggesting that decrease in A(sat) may have been the main feature associated with the visible foliar symptons.

[Duodenal duplication cyst filled with enteroliths: a case report]

Acta Gastroenterol Latinoam. 2009 Jun; 39(2): 125-8
Leite AK, David AI, Szutan LA

Alimentary tract duplications are very rare, especially among adults, and only in 4-12% of the cases the duodenum is the site of origin. The main symptoms are usually epigastric pain, weight loss and vomiting. We report a case of a duodenal duplication cyst filled with enteroliths in a 23-year-old female patient presenting these symptons. The computed tomography showed a mesenteric cyst and the patient underwent a surgical procedure during which the diagnosis of duplication cyst with enteroliths was made and the cyst was excised with success. The diagnosis before surgery in these cases is extremely difficult especially if one considers how rare they are. The most helpful exam is the computed to- mography and the treatment is mainly surgical, although there are recent case reports showing the possibility of endoscopic resection (still being discussed). The presence of enteroliths can be explained by stasis and food alkalinity inside the cyst.

Prostaglandin I(2) (epoprostenol) triggers migraine-like attacks in migraineurs.

Cephalalgia. 2009 Jul 9;
Wienecke T, Olesen J, Ashina M

Wienecke T, Olesen J & Ashina M. Prostaglandin I(2) (Epoprostenol) triggers migraine-like attacks in migraineurs. Cephalalgia 2009. London. ISSN 0333-1024Prostacyclin [prostaglandin I(2) (PGI(2))] activates and sensitizes meningeal sensory afferents. In healthy subjects PGI(2) triggers headache in healthy subjects. However, the migraine-eliciting effect of PGI(2) has not been systematically studied in patients with migraine. We hypothesized that intravenous infusion of the stable prostacyclin analogue epoprostenol would trigger migraine-like attacks in migraineurs. We infused 10 ng kg(-1) min(-1) PGI(2) or placebo over 25 min in 12 migraineurs without aura in a controlled, double-blind, cross-over study and recorded headache intensity and associated symptons, velocity in the middle cerebral artery (V(MCA)) and diameter in the superficial temporal artery. In the period 0-14 h, 12 subjects reported headache on PGI(2) day compared with three subjects on placebo day (P = 0.004), and six subjects fulfilled the criteria for an experimentally induced migraine-like attack compared with two subjects on placebo (P = 0.219). During infusion and post-infusion phases the AUC under the headache curve on PGI(2) was significantly larger than on placebo (P < 0.05). There was a significant V(MCA) decrease (P = 0.015) and superficial temporal artery diameter increase (P < 0.001) on PGI(2) compared with placebo. In conclusion, PGI(2) may trigger a migraine-like attack in migraine sufferers. We suggest sensitization of perivascular nociceptors and arterial dilation as the mode of action of PGI(2)-induced headache and migraine-like attacks.

[Neisseria gonorrhoeae infections]

Nippon Rinsho. 2009 Jan; 67(1): 129-35
Furuya R, Tanaka M

Neisseria gonorrhoeae infections are common bacterial sexually transmitted diseases. Men will usually experience lower urinary tract symptons attributed to urethritis, epididymitis, proctitis, or prostatitis, with associated mucopurulent urethral discharge. Many women are asymptomatic. But, occasionally, they have symptons of vaginal and pelvic discomfort of dysuria, and these infections can lead to pelvic inflammatory disease. Recentry, high prevalence of Neisseria gonorrhoeae isolates resistant to antimicrobial agents is a serious problem in the treatment of gonorrhea. For example, in Fukuoka city, Japan, the proportion of the isolates resistant to ciprofloxacin (CPFX) were 73.4% in 2006 and it was still so high. The proportion of the isolates resistant to tetracycline (TC) was 38.5% in 2006 and that of isolates resistant to penicillin G (PCG) was 17.5%. Owing to this high prevalence of antimicrobial-resistant Neisseria gonorrhoeae in Japan, the clinical efficacy rates of oral antimicrobial agents have become lower. So, as first-line therapy for gonococcal infections, only three parenteral regimens of single doses of ceftriaxone, cefodizime or spectinomycin are recommended by the Japanese Society for Sexually Transmitted Diseases. In the circumstances, we studied in vitro activity of combinations of oral agents such as, beta-lactam and azithromycin, fluoroquinolone and azithromycin, or beta-lactam and fluoroquinolone against Neisseria gonorrhoeae. The cefixime+azithromycin combination demonstrated greater synergy than other combinations.

Marine toxins and the cytoskeleton: okadaic acid and dinophysistoxins.

FEBS J. 2008 Dec; 275(24): 6060-6
Vale C, Botana LM

Okadaic acid (OA) and its analogs, the dinophysistoxins, are potent inhibitors of protein phosphatases 1 and 2A. This action is well known to cause diarrhea and gastrointestinal symptons when the toxins reach the digestive tract by ingestion of mollusks. A less well-known effect of these group of toxins is their effect in the cytoskeleton. OA has been shown to stimulate cell motility, loss of stabilization of focal adhesions and a consequent loss of cytoskeletal organization due to an alteration in the tyrosine-phosphorylated state of the focal adhesion kinases and paxillin. OA causes cell rounding and loss of barrier properties through mechanisms that probably involve disruption of filamentous actin (F-actin) and/or hyperphosphorylation and activation of kinases that stimulate tight junction disassembly. Neither methyl okadaate (a weak phosphatase inhibitor) nor OA modify the total amount of F-actin, but both toxins cause similar changes in the F-actin cytoskeleton, with strong retraction and rounding, and in many cases cell detachment. OA and dinophysistoxin-1 (35S-methylokadaic acid) cause rapid changes in the structural organization of intermediate filaments, followed by a loss of microtubules, solubilization of intermediate filament proteins, and disruption of desmosomes. The detailed pathways that coordinate all these effects are not yet known.

[How to treat anorexia nervosa?--case report]

Ginekol Pol. 2007 Dec; 78(12): 990-4
Podfigurna-Stopa A, Meczekalski B, Warenik-Szymankiewicz A

Anorexia nervosa is an eating disorder characterized by low body weight and body image distortion with obsessive fear of gaining weight. It is a complex condition involving psychological, neuroendocrine, hormonal and metabolic components. The following is a case report of a young patient diagnosed as anorexia nervosa and primary amenorrhea, without the development of secondary female characteristics. Hormonal examination confirmed hypothalamic origin of the described disorders. There was an important impairment in the mood sphere (Beck's Depression Inventory and Hamilton Depression Rating Scale) of this young woman. Densitometry of lumbar spine revealed significant bone loss (diagnozed as osteoporosis) in this patient. All of the abovementioned examinations were repeated after one and a half years of hormonal treatment (estrogen-progestins). A return of normal menstrual cycle (with ovulation function) and normal hormonal profile have been observed. After one and a half years of treatment the patient had regular feeding patterns and none of the anorexia nervosa symptons have been found. A significant improvement in Beck's Depression Inventory and Hamilton Depression Rating Scale was found after one and a half years of hormonal treatment. The patient was also characterized by important increase of bone mass density--osteopenia was described by the densitometry of the lumbar spine.

[Epidural blood patch for intracranial hypotension with closed system in a Jehovah's Witness]

Masui. 2007 Aug; 56(8): 953-5
Tanaka T, Muratani T, Kusaka Y, Minami T

We report a case of treating intracranial hypotension with an epidural blood patch using closed system that allows blood collection and epidural injection without loss of continuity. The patient was a 34-year-old woman with severe headache for several months. The headache failed to respond to conservative management. By radioisotope cisternography, it was diagnosed as intracranial hypotension. Epidural blood patch was planned for intracranial hypotension. We used the method of epidural blood patch in a closed venous blood transfusion system to the epidural space, because she is a member of the Jehovah's Witness. Twenty five ml of blood was drawn into the syringe and injected into the epidural space with closed system. The patient was discharged home after 3 days with dramatically reduced symptons. Epidural blood patching with closed system is a safe, and effective procedure that is acceptable to a Jehovah's Witness.

[Case of ruptured superior cerebellar artery dissection treated by endovascular embolization]

Brain Nerve. 2007 Jan; 59(1): 72-5
Iko M, Kazekawa K, Aikawa H, Onizuka M, Tanaka A

The authors herein report a case of a ruptured dissection of the superior cerebellar artery (SCA). A 68-year-old man presented with symptons of sudden headache and nausea. The CT scan revealed the presence of both a subarachnoid hemorrhage (SAH) and acute hydrocephalus. The left vertebral angiogram showed an fusiform dilatation in the cerebellomesencephalic segment of the left SCA. Endovascular embolization of the aneurysm and SCA was successfully performed using Guglielmi detachable coils (GDCs). No delayed ischemic deficits were observed after the treatment. A dissection of the distal segment of the SCA is a very rare occurrence. We believe endovascular embolization using GDCs to be an effective and less invasive therapy for the treatment of an SCA dissection with SAH.

[Case report of an elderly woman who developed a pain disorder following her husband's death]

Seishin Shinkeigaku Zasshi. 2006; 108(11): 1142-50
Yamamoto K, Onishi Y, Abe T, Kato S

We present the case of an elderly woman who developed a pain disorder following her husband's death. This patient consulted two or three gynecology clinics with anxiety due to external genital pain, the cause of which could not be identified. Subsequently, the patient came to our university hospital where she was diagnosed with "pain disorder" and "depression" by a psychiatrist. With medication and supportive psychotherapy, the patient showed positive clinical progress. The operational diagnosis of pain disorder was useful as it permitted the establishment of a diagnosis for a patient with pain, the cause of which could not be identified. In this case, the patient's external genital pain was thought to be a symptom of her loss of sexual identity and her depression following the death of her husband. It has been reported that such somatic pain appears when the patient does not mourn, leading to pathological symptons. Therefore, in supportive psychotherapy, it is important to listen carefully to the patients' complaints about their pain in order to provide them with the opportunity to finish grieving. As a complementary therapy to SSRI medication, supportive psychotherapy contributed strongly to this case's recovery.

[Changes in the clinical and anatomo-pathological presentation of prostate cancer in Oviedo in the last 10 years (part I)]

Actas Urol Esp. 2006 Nov-Dec; 30(10): 974-9
Alvarez-Múgica M, Fernández Gómez JM, Escaf Barmadah S, Jalón Monzón A, González Alvarez RC, Regadera Sejas FJ

OBJECTIVES: To describe the clinical and pathological factors of prostate adenocarcinomas diagnosed in our department in the years 1995 and 2004. MATERIAL AND METHOD: We review the 216 patients diagnosed in both years, recording several features. RESULTS: The mean age was significatively lower in the year 2004. In that year, the increments of the PSA levels was the main reason for the diagnosis of the prostate cancer, followed by low urinary tract symptons (LUTS), while the LUTS was the main reason in 1995. There was a greater proportion of high grade tumors in 1995 and also in this year, high risk tumors were the most frequently found, while in 2004 low risk and low grade tumors were predominant. CONCLUSIONS: Due to the general determinations of PSA levels in asymptomatic patients in 2004, we found a greater proportion of high grade tumors in 1995 and lower grade tumors in 2004.

[Case of ruptured superior cerebellar artery dissection treated by endovascular embolization]

No To Shinkei. 2007 Jan; 59(1): 72-5
Iko M, Kazekawa K, Aikawa H, Onizuka M, Tanaka A

The authors herein report a case of a ruptured dissection of the superior cerebellar artery (SCA). A 68-year-old man presented with symptons of sudden headache and nausea. The CT scan revealed the presence of both a subarachnoid hemorrhage (SAH) and acute hydrocephalus. The left vertebral angiogram showed an fusiform dilatation in the cerebellomesencephalic segment of the left SCA. Endovascular embolization of the aneurysm and SCA was successfully performed using Guglielmi detachable coils (GDCs). No delayed ischemic deficits were observed after the treatment. A dissection of the distal segment of the SCA is a very rare occurrence. We believe endovascular embolization using GDCs to be an effective and less invasive therapy for the treatment of an SCA dissection with SAH.

[Cluster like headache in a patient with the Maffucci's syndrome]

No To Shinkei. 2006 Jun; 58(6): 514-7
Kitamura E, Imai N, Konisi T, Suzuki Y, Serizawa M, Okabe T

Maffucci's syndrome is a rare congenital, nonhereditary mesodermal dysplasia characterized by soft tissue hemangiomas and multiple enchondromas. A 52 years old man was diagnosised as Maffucci's syndrome in his childhood. He complained of mild paraesthesia which gradually progressed to intolerable pain lasting one to two houres with rhinorrhea (cluster like headache). Magnetic resonance imaging showed a pituitary adenoma which invaded into right cavernous sinus. Serum hormone level was almost normal, therefore we diagnosed nonfunctional pituitary adenoma. The pharmacological preventive treatments for headache, such as loxoprofen, sumatriptan, lomerizine had no effect. On the other hand, verapamil showed moderate improvement of his headache, then the symptons was gradually getting better and finally he felt no pain. This case demonstrated occurence mechanism of cluster headache and preventive effect of verapamil associated with cavernous sinus.

Typical symptons and atypical radiographic findings in a case of chronic eosinophilic pneumonia.

Respir Care. 2006 Jul; 51(7): 764-7
Luks AM, Altemeier WA

[Fluticasone propionate aqueous nasal spray for the treatment of chronic sinusitis with eosinophil]

Nippon Jibiinkoka Gakkai Kaiho. 2006 Mar 20; 109(3): 157-62
Ohta Y, Tsubaki K, Yamamoto M, Makino N, Ishikawa T, Ichimura K

Chronic sinusitis with eosinophils easily recurs after endoscopic sinus surgery. The condition is usually complicated by asthma, and many eosinophils are present in the sinus mucosa. One conservative treatment method is the administration of glucocorticoids locally or systematically. To evaluate the efficacy and tolerability of intranasal fluticasone propionate for the treatment of chronic sinusitis with eosinophils, seven patients with chronic sinusitis with eosinophils were treated over a 12-week period using a fluticasone propionate aqueous nasal spray (800 microg per day in each nostrilz). The Symptons of 7 patients, especially nasal discharge and nasal obstructions, improved and an expanded air space was observed on paranasal CT images. The percent of drug systemically available after intranasal administration varied by less than 1% for intranasal fluticasone propionate. Therefore, even if intranasal fluticasone propionate is administerved at double the usual dose, it is unlikely to cause systemic side effects. Fluticasone propionate aqueous nasal spray at double the usual dose is effective for the treatment of chronic sinusitis with eosinophils.

[Some aspects to consider of the medicine in the beginnings of the XXI century]

An R Acad Nac Med (Madr). 2005; 122(3): 529-40; discussion 540-5
Schüller Pérez A

The medical science based on the structure knowledge and the man's function, illness cause and of their treatment. The Medicine aspires to get the cure, remission of the symptons and illness signs recovering the normality or restitution ad integrum, with the same residual syndrome and treatment of this, and well being cardiovascular, digestive, haematological, psychological. In short, the doctor is the widest treatment and better thing possible of sick persons in their aspects etiological, physiological and evolutionary, with the depth that nowadays is necessary to make, it means, in their cellular and enzymatic aspects of the alterative processes. The advances of the medicine and methodology, diagnostic and medical-surgical treatments have imposed formative modifications of the curriculum to be upgraded, new current challenge to elevate the quality of that, increasing the knowledge of each illness, of their individual repercussion and capacity to injure the organ and systems, cellular and functional, enzymatic, as well as of vital recovery and the answers to the immunologic, clinical and surgical preventive treatments, and to avoid complications and relapses. To obtain good results assuring a correct evolution and development of the medicine, the objectives and ends of the medical teaching basic and clinical scientific innovations, to have enough number of very prepared educational collaborators and to improve the teaching of the doctorale and of medical-surgical specialities.

[Adult celiac disease: clinical experience]

Rev Med Chil. 2005 Nov; 133(11): 1317-21
Mancilla A C, Madrid S AM, Valenzuela E J, Morales B A, Hurtado H C, Smok S G, Ledezma R R, Castillo M I, Rivas Q M, Brahm B J

BACKGROUND: The prevalence of celiac disease (CD) is unknown in Chile. We have recently noted a rise in the number of cases diagnosed among adults. AIM: To describe the clinical characteristics of a group of adult celiac patients. PATIENTS AND METHODS: Clinical data of patients older than 15 years with positive antitransglutaminase or antiendomysial autoantibodies and a duodenal biopsy characteristic of CD were retrospectively reviewed. Age at diagnosis, symptoms and signs and laboratory, endoscopic and histological findings, were analyzed. RESULTS: Thirty seven patients (28 women), were studied. Median age at diagnosis was 41 years (range 15-69). Main symptoms and signs were diarrhea (78%), weight loss (38%) and abdominal pain (38%). Anemia was found in 49%, elevation of ESR in 57%, elevation of alkaline phosphatases in 54%, elevation of aspartate aminotransferase in 38% and a rise in alanine aminotransferase in 27%. Antiendomysial antibodies were positive in 17/22 (77%) and antitransglutaminase in 19/22 (86%) patients. Endoscopic findings were suggestive of CD in 47% of cases and duodenal biopsy showed intestinal villi atrophy in 34 (92%) patients. The three patients with normal histology had positive serology and a good response to gluten free diet. CONCLUSIONS: CD should be considered in the differential diagnosis of patients with unespecific digestive symptons, even when they present late in adult life. Serologic markers are a good diagnostic tool. A normal duodenal pathology does not exclude the diagnosis, if other diagnostic features are present.

[Nutritional repercussion in advanced heart failure and its value in prognostic assessment.]

Arq Bras Cardiol. 2005 Jun; 84(6): 480-5
Veloso LG, de Oliveira MT, Munhoz RT, Morgado PC, Ramires JA, Barretto AC

OBJECTIVE: To analyze the nutritional repercussion in heart failure and its relations with left ventricular dysfunction and mortality. METHODS: A series of nutritional parameters in a group of 95 patients with advanced chronic heart failure, arising out of dilated cardiomyopathy and age < 65 years old, without concomitant diseases was studied. The duration of symptons, final diastolic diameter and left ventricular ejection fraction were verified. The nutritional assessment, included the ideal percentage of weight the triceps skin fold thickness, percentiles of circumference of muscular mass of the arm, the albumin serum levels and the lymphocytes global count. RESULTS: The nutritional situation was alterated in 45.3% to 94.7% of the patients in accordance to the assessment parameter used. There was neither correlation between the nutritional parameters and the length of symptoms, nor with the ventricular dysfunction level. That group of patients had a homogenous evolution, and 75.8% of them died in an average time of 21.86 weeks. The left ventricular diastolic diameter and ejection fraction did not allow for the prediction of survival. A diminished body mass identified a group with higher risk of death. The ideal percentage of the body mass was predictive of survival (p=0.0352), the patients with less than 80% of ideal weight had a higher relative risk of death of 1.99 (1.12-3.02) (p=0.0132). CONCLUSION: Malnutrition is frequent in patients with advanced heart failure and dilated cardiomyopathy. The reduced body mass was a better predictor of survival than the left ventricular ejection fraction in patients under advanced stage of myocardial compromising.

[Inverted nasosinusal papilloma. 11 cases and bibliographic revision]

An Otorrinolaringol Ibero Am. 2005; 32(3): 279-89
Alonso Párraga D, Clemente García A, Sánchez Ruiz D, González Prado A

INTRODUCTION: We present the cases registred from 1998 to 2003 and a revision of the bibliography. MATERIAL AND METHOD: In the section of Rhinology of a second level Hospital 11 patients affected by inverted papilloma type 1 of the OMS classification were diagnosed aged between 40 and 79, 9 men and 2 women. They were explored through endoscopy and biopsy and the exeresis of the lesion was done by endoscopic polipectomy with microdebrider (PEM). RESULTS: All the cases at stage I, II and III of the Krouse classification. Treated by CEN, 6 by mixed endonasal approach and through the canine fossa 4 by nasal approach only and 1 by Caldwell-Luc approach. The follow-up was done between 9 to 64 months and there was a recidive who was operated by open surgery and no one malignant transformation was seen. DISCUSSION: We coment the aspects related to etiology, the symptons and the surgical technics. CONCLUSIONS: We propose to stage the tumor and the realisation of a PEM with topic anesthesia with deep biopsies in all unilateral poly formations to avoid a retarded diagnosis and to be able to apply endoscopic technics.

[A travel abroad-associated case of Legionella pneumonia diagnosed by urinary antigen detection test]

Kansenshogaku Zasshi. 2005 Apr; 79(4): 290-3
Ishii Y, Bando M, Ohno S, Sugiyama Y

A 75 year-old male was admitted to our hospital with high fever and dyspnea. He had traveled in Turkey 10 days before. His chest X-ray showed infiltrations in bilateral lower lung fields. His urinary antigen detection test for Legionella pneumophilia was positive. He was treated with pazufloxacin added to clarithromycin and his symptons were promptly resolved.