scholarly journals Our Experience in Pulsatile Tinnitus and a Normal Tympanic Membrane in 66 Patients

2019 ◽  
Vol 2 (02) ◽  
pp. 56-58
Author(s):  
Abdelrahman E. M. Ezzat ◽  
Mohammed A. Salem ◽  
Colin O’Rourke ◽  
John E. Fenton

Abstract Introduction Pulsatile tinnitus (PT) can harbor potentially life-threatening conditions (LTCs), whereby a delay in diagnosis could be disastrous. Objective The purpose of this study was to ascertain whether associated signs and symptoms at presentation could help identify a subgroup of high-risk patients. Materials and Methods A total of 66 patients with PT were retrospectively assessed. The diagnoses were classified as group I with an LTC or not in group II. Results There were 4 patients (6%) with a final diagnosis of LTC (group I) and 62 patients (94%) without a final diagnosis of LTC or no diagnosis (group II). The results were not quite statistically significant regarding the trauma and were strongly statistically significant regarding headache and the cranial nerve paralysis. Conclusion The combination of PT with any of the three features of occipital headache, cranial nerve palsy, and recent trauma should alert the clinician to potentially serious causes.

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Lorenzo Storari ◽  
Valerio Barbari ◽  
Fabrizio Brindisino ◽  
Marco Testa ◽  
Maselli Filippo

Abstract Background Shoulder pain (SP) may originate from both musculoskeletal and visceral conditions. Physiotherapists (PT) may encounter patients with life-threatening pathologies that mimic musculoskeletal pain such as Acute Myocardial Infarction (AMI). A trained PT should be able to distinguish between signs and symptoms of musculoskeletal or visceral origin aimed at performing proper medical referral. Case presentation A 46-y-old male with acute SP lasting from a week was diagnosed with right painful musculoskeletal shoulder syndrome, in two successive examinations by the emergency department physicians. However, after having experienced a shift of the pain on the left side, the patient presented to a PT. The PT recognized the signs and symptoms of visceral pain and referred him to the general practitioner, which identified a cardiac disease. The final diagnosis was acute myocardial infarction. Conclusion This case report highlights the importance of a thorough patient screening examination, especially for patients treated in an outpatient setting, which allow distinguishing between signs and symptoms of musculoskeletal from visceral diseases.


2004 ◽  
Vol 12 (1) ◽  
pp. 39-44 ◽  
Author(s):  
Leonardo Rigoldi Bonjardim ◽  
Maria Beatriz Duarte Gavião ◽  
Luciano José Pereira ◽  
Paula Midori Castelo

This research aimed to evaluate mandibular movements in children with and without signs and symptoms of temporomandibular dysfunction. The sample taken consisted of 99 children aged 3 to 5 years distributed in two groups: I - Absence of signs and/or symptoms of TMD (25 girls/40 boys); II - Presence of signs and symptoms of TMD (16 girls/18 boys). The symptoms were evaluated through an anamnesis questionnaire answered by the child's parents/caretakers. The clinical signs were evaluated through intra- and extraoral examination. Maximum mouth opening and left/right lateral movements were measured using a digital caliper. The maximum protrusive movement was measured using a millimeter ruler. The means and standard deviations for maximum mouth opening in Group I and Group II were 40.82mm±4.18 and 40.46mm±6.66, respectively. The values found for the left lateral movement were 6.96mm±1.66 for Group I and 6.74mm±1.55 for Group II, while for the right lateral movement they were 6.46mm±1.53 and 6.74mm±1.77. The maximum protrusion movements were 5.67mm±1.76 and 6.12mm±1.92, in Groups I and II, respectively. The mandibular movement ranges neither differed statistically between groups nor between genders. FAPESP Process 96/0714-6.


1994 ◽  
Vol 1 (1) ◽  
pp. 88-91 ◽  
Author(s):  
John R. Crew ◽  
Marilyn Thuener

Purpose: The standard endpoint for lower limb revascularization is long-term patency; however, in high-risk patients with end-stage ischemia, healing of chronic ulcerations has been proposed as an acceptable endpoint. To evaluate if today's minimally invasive interventions, in combination with comprehensive wound healing procedures, can resolve nonhealing wounds, we performed a retrospective review of chronic ulceration patients treated at the San Francisco Wound Care Center. Methods: Eight-five patients with 96 limbs at risk due to nonhealing ulcers were treated with a variety of endovacular procedures: 7 patients (group 1) received PalmazR stents for unilateral iliac occlusions; 42 limbs (group II) in 39 patients were treated with balloon angioplasty for superficial femoral and popliteal lesions; and 47 extremities in 39 patients (group III) underwent rotational atherectomy for tibioperoneal lesions. Comprehensive wound management techniques, including the application of growth factors, were used. Results: All group I wounds healed, although 6 of 7 patients required additional procedures to address outflow lesions. In groups II and III, primary patencies were similar (64% and 70%, respectively), and nine treated sites reoccluded in each group. Restenotic lesions were retreated in both groups (three in group II and four in group III); secondary patencies were 71% and 78%, respectively. There were more amputations in group III patients (five) compared to group II (one). In both groups after 5 months, 90% of wounds had healed in group II and 72% in group III. Conclusion: The use of endovascular procedures appears to play an important role in the healing of chronic lower extremity ulcerations in high-risk patients with end-stage ischemia.


2021 ◽  
Vol 8 (2) ◽  
pp. 244-249
Author(s):  
Dhiraj Dhoot ◽  
Piyush Prabhat ◽  
Lalita Mayadeo ◽  
Harshal Mahajan

One of the most striking change in the current scenario is the increasing occurrence of non-albicans vulvovaginal candidiasis (VVC), which is considered as the major cause of recurrence, relapse and chronic VVC in India. In the present study we evaluated the effectiveness of three different regimens of itraconazole in the treatment of acute VVC.The present randomised, three arm comparative clinical study involved 123 women aged 18 years or above with symptomatic acute VVC. These patients were randomised (41 patients in each group) to receive either itraconazole 200 mg twice daily for 1 day (group I), 200 mg twice daily for 2 days (group II) or 100 mg twice daily for 3 days (group III). Effectiveness was evaluated on the basis of clinical cure (total symptom score), mycological cure (negative KOH test). All the groups were effective in relieving signs and symptoms (p<0.05), but on comparison between all groups, there was statistical difference between Group II and Group I & III (p<0.05) and Group III & I (p<0.05). Complete cure i.e. disappearance of signs and symptoms and negative KOH test was maximum in group II (44%) as compared to groups I (12%) and III (17% of the patients). Relapse was least in seen in 11 patients (27%) in Group I, 3 patients (7%) in Group II and 7 patients (17%) in Group III. All the 3 regimens were well tolerated.In the present study, 2 day high dose itraconazole therapy was found to have better effectiveness compared to conventional regimens. Longer duration of therapy might be required to attain even better cure rates, especially when the incidence of Non Albicans vulvovaginal candidiasis is rising in all parts of the country.


2006 ◽  
Vol 24 (18_suppl) ◽  
pp. 4654-4654 ◽  
Author(s):  
K. Touijer ◽  
F. Rabbani ◽  
J. Romero Otero ◽  
F. Secin ◽  
B. Guillonneau

4654 Background: To determine if pelvic lymph node dissection (LND) can be omitted in prostate cancer patients at low risk of nodal metastases according to the Partin tables and to determine the yield on extended vs limited LND in patients at high risk to better define the appropriate template of dissection. Methods: A total of 577 patients with clinically localized prostate cancer underwent a laparoscopic radical prostatectomy (LRP). In the first 363 patients, a cutoff of 1% on the Partin tables’ predicted probability of lymph node invasion (PPLNI) was used to select patients for a limited LND (external iliac nodes only). In the subsequent 214 patients, all patients underwent an extended LND (external iliac, obturator and hypogastric nodes). Patients were classified into 4 groups: Group I, 186 patients with a PPLNI ≤1%, did not undergo a LND; Group II, 110 patients with PPLNI ≤ 1%, underwent an extended LND; Group III, 177 patients with PPLNI >1% underwent a limited LND and Group IV, 104 patients with PPLNI >1%, underwent an extended LND. We compared Group I and II to assess the value of the Partin tables in selecting low risk patients for nodal metastasis. Multivariate logistic regression analysis was performed to compare the node positivity rate between groups III and IV, controlling for preoperative and pathological parameters. Results: None of the patients in group II had a positive lymph node after an extended LND. On multivariate analysis, controlling for PSA, biopsy Gleason, clinical stage, pathological Gleason and stage, and seminal vesicle invasion, the extended LND independently impacted the rate of node positivity with a relative risk (RR) of 15.6 (95% CI 3.7 -66.4, p < 0.001). The median (mean) number of nodes retrieved was 9 (10) and 14 (15) after limited and extended LND respectively (p < 0.001). Conclusions: A lymph node dissection including the external iliac, obturator and hypogastric lymph node groups yields positive nodes more frequently and retrieves a higher total nodal count than the often-performed LND limited to the external iliac nodes. Decision to forgo LND in low risk patients needs to be validated by long-term biochemical recurrence data No significant financial relationships to disclose.


Blood ◽  
2004 ◽  
Vol 104 (11) ◽  
pp. 5178-5178
Author(s):  
Tokiko Nagamura-Inoue ◽  
Cui Yan ◽  
Hideki Kodo ◽  
Hideo Mugishima ◽  
Michiko Sugo ◽  
...  

Abstract Recently, cord blood transplantation (CBT) for adult is rapidly increasing in number, Especially for the patients over 50 years of age. By the end of 2003, 224 units were shipped for the patients Group I: <15 y.o. 39%, Group II: 15~50 y.o.40% and Group III :> 50 y.o.21%. We analyzed 152 patients with hematological malignancies including ALL, AML, CML, MDS, malignant lymphoma, myeloma and neuroblastoma reported from CBT center in the world by the end of 2003. Patients and Methods:Group I included 58 patients with 13 standard risk and 45 high risk patients and showed mean±SD of age; 5.3 ±4.1y.o.,BW; 20.5±13.4kg, CB volume at collection; 91.6±27.1ml, NC; 5.5±3.3x107/kg, CFC; 8.6±6.4x104/kg, CD34; 1.5±1.1x105/kg, Group II: 64 cases with 25 standard and 39 high risk patients and age; 30.6±10.3y.o., BW; 51.9±9.5kg, CB volume at collection;116.6±27.7ml, NC;2.6±0.7x107/kg, CFC;5.2±2.6x104/kg and CD34;0.8±0.5x105/kg, Group III: 30 cases with 9 standard and 21 high risk patients and age; 54.1±3.3y.o., BW;55.9±11.0kg, CB vol.at collection;118.8±24.7ml NC;2.4±0.4x107/kg, CFC;4.8±1.9x104/kg and CD34;0.8±0.4x105/kg. The patients who underwent CBT for graft failure (GF) of prior transplant were excluded. Conditioning regimen in Group I demonstrated 54 patients with full regimen and 4 with reduced intensity regimen (RIST); in Group II, 62 patients with full regimen and 2 RIST; and in Group III, 14 cases full regimen and 15 cases RIST. Results: Cumulative myeloid engraftment was seen 67.2% in Group I, 73.4% in Group II and 46.7% in Group III (*Group II vs. Group III: P<0.05). Overall survival /EFS on day 100 showed 73.4%/59.4% in Group I, 74.0%/58.6% in Group II and 43.3%/34.5% in Group III (*Group III vs. others: P<0.05). In Group III, the survival rate indicated 42.8% in full regimen group and 13.3% in RIST group at 1year after CBT. In Group I, four patients died of GF, 13 of relapse, 11 of Transplantation related disease (TRD); in Group II, 5 patients died of GF, 8 of TRD, 10 of relapse. In Group III, four patients died of TRD, 3 of GF and 3 of relapse in full regimen, while in RIST, six patients died of TRD, 1 of relapse and 1 of acute GVHD. Conclusion: The application of CBT has been expanded to the elderly patients (>50 y.o.), although the conditioning regimen and the special medical care for the complications in the early pahse after UCBT has remained to be discussed.


Blood ◽  
2006 ◽  
Vol 108 (11) ◽  
pp. 704-704
Author(s):  
Siavash Piran ◽  
Pingguo Chen ◽  
Guangheng Zhu ◽  
Hong Yang ◽  
Michelle Webster ◽  
...  

Abstract Fetal and neonatal alloimmune thrombocytopenia (FNAITP) is a life-threatening bleeding disorder which results from maternal anti-platelet antibodies that cross the placenta and destroy fetal platelets. In most cases FNAITP is mediated by anti-β3 integrin antibodies, whereas reported cases of anti-GPIbα mediated FNAITP are rare. This difference can not be solely explained by the frequency of their respective polymorphisms. It is unclear whether this is due to:the GPIbα antigen being less immunogenic, resulting in less maternal antibody generation during pregnancy, oranti-GPIbα antibodies mediating a less severe pathology, resulting in a reduced number of reported cases. To study the immunogenecity and antibody response to the GPIbα antigen, GPIbα deficient mice (GPIbα−/−, Black Swiss background) were transfused with wild-type (WT) platelets. No detectable anti-GPIbα IgG antibody was induced even after 8 transfusions (108 platelets/transfusion). This clearly differs from the immune response generated in β3 integrin deficient (β3−/−, BALB/c background) mice, in which anti-β3 integrin antibody can be easily detected after 2–4 WT platelet transfusions. This suggested that the MHC complex in Black Swiss mice might not be able to present the GPIbα antigen. We thus introduced the BALB/c background to the GPIbα−/− mice via backcrossing these mice with BALB/c mice for 9 generations (F9). To further minimize genetic background differences, the F9 BALB/c GPIbα−/− mice were bred with F9 BALB/c β3−/− mice to generate heterozygous BALB/c GPIbα+/− and β3+/− mice. These mice were subsequently used to generate littermate GPIbα−/− or β3−/− mice for the following studies. We found that BALB/c GPIbα−/− mice are immunoresponsive to the GPIbα antigen, but antibody titers after 2 and 4 platelet transfusions were significantly lower than those seen with the anti-β3 integrin model (1:50 & 1:200 vs 1:400 & 1:3200 respectively, P&lt;0.05). We then established a FNAITP model with these GPIbα−/− mice and compared it with syngeneic background β3−/− mice. Naïve (Group I) or 2-time-platelet-immunized (Group II) female GPIbα−/− or β3−/− mice were bred with WT male mice. In Group I, neonatal platelet counts after the first delivery were normal and no maternal antibody was detected for both groups. After the third delivery, GPIbα+/− pups did not have any bleeding disorders and the maternal antibody was also negative. In contrast, 14.3% of β3+/− pups were stillborn or had subcutaneous bleeding and maternal antibody was detected. In Group II, 8 pups were delivered from a GPIbα−/− female and 2 of them have minor intestinal and subcutaneous bleeding. 10 pups were delivered from 2 β3−/− female mice and 6 of them were stillborn. Of these dead pups, there was 1 case of intracranial hemorrhage and 2 immature pups. When the anti-GPIbα antibody level was increased via 4 platelet transfusions, a GPIbα−/− female had a miscarriage and severe FNAITP was observed. Our preliminary data suggested that fewer FNAITP cases reported with alloantibodies against GPIbα might not be due to the severity of FNAITP caused by this antibody, but is more likely because GPIbα is less immunogenic with a limited repertoire of MHC in pregnant women.


Author(s):  
Abd El-Naser Abd El-Gaber Ali ◽  
Ahmed Ali M. Nasr ◽  
Hazem H. Ahmed ◽  
Mahmoud I. El- Rasheedy ◽  
Mahmoud Badawy

Background: Post-partum hemorrhage prevention (PPH) is considered a major issue due to its effect on maternal morbidity and mortality. The objective of this study was to compare efficacy of Carbetocin in prevention of atonic post-partum hemorrhage in high risk patients undergoing elective caesarean section in comparison to Oxytocin and Misoprostol.Methods: 150 pregnant women prepared for elective caesarean section were classified into 3 groups; Group I (50 patients received Carbetocin 100 mg I.V infusion), Group II (50 patients received 20 IU of Oxytocin infusion on 1000 ml of normal saline solution) and Group III (50 cases received Misoprostol 400 µg per rectum immediately before induction of anaesthesia). Assessment of PPH and its degree was determined according to amount of blood loss during and for first 24 hours of caesarean delivery, also further need for haemostatic measures were also assessed.Results: There was a statistically significant difference in PPH among the three groups 6, 14 and 12% for group I, II and III respectively (P <0.001), major PPH was 0, 4 and 6% for the same groups respectively (P <0.001). The need for additional uterotonic agents was significantly lesser in Group I compared to Group II and III (2% versus 8 and 12% respectively P = 0.02) also the need for additional surgical measures was significantly lesser among the three groups (P= 0.00). The drop in Hb level and haematocrit value was significantly lesser in group I compared to group II& III (P <0.05). The need for blood transfusion was significantly lesser in Group I compared to group II and III (0% versus 12% p <0.0001)Conclusions: Carbetocin was superior to Oxytocin and Misoprostol in prevention of atonic PPH in high risk patients underwent elective caesarean delivery. Carbetocin should be administered for all cases undergoing elective CS and carry a risk factor for postpartum hemorrhage. 


2011 ◽  
Vol 29 (10) ◽  
pp. 1312-1318 ◽  
Author(s):  
R. Beverly Raney ◽  
David O. Walterhouse ◽  
Jane L. Meza ◽  
Richard J. Andrassy ◽  
John C. Breneman ◽  
...  

Purpose Patients with localized, grossly resected, or gross residual (orbital only) embryonal rhabdomyosarcoma (ERMS) had 5-year failure-free survival (FFS) rates of 83% and overall survival rates of 95% on Intergroup Rhabdomyosarcoma Study Group (IRSG) protocols III/IV. IRSG D9602 protocol (1997 to 2004) objectives were to decrease toxicity in similar patients by reducing radiotherapy (RT) doses and eliminating cyclophosphamide for the lowest-risk patients. Patients and Methods Subgroup A patients (lowest risk, with ERMS, stage 1 group I/IIA, stage 1 group III orbit, stage 2 group I) received vincristine plus dactinomycin (VA). Subgroup B patients (ERMS, stage 1 group IIB/C, stage I group III nonorbit, stage 2 group II, stage 3 group I/II) received VA plus cyclophosphamide. Patients in group II/III received RT. Compared with IRS-IV, doses were reduced from 41.4 to 36 Gy for stage 1 group IIA patients and from 50 or 59 to 45 Gy for group III orbit patients. Results Estimated 5-year FFS rates were 89% (95% CI, 84% to 92%) for subgroup A patients (n = 264) and 85% (95% CI, 74%, 91%) for subgroup B patients (n = 78); median follow-up: 5.1 years. Estimated 5-year FFS rates were 81% (95% CI, 68% to 90%) for patients with stage 1 group IIA tumors (n = 62) and 86% (95% CI, 76% to 92%) for patients with group III orbit tumors (n = 77). Conclusion Five-year FFS and OS rates were similar to those observed in comparable IRS-III patients, including patients receiving reduced RT doses, but were lower than in comparable IRS-IV patients receiving VA plus cyclophosphamide. Five-year FFS rates were similar among subgroups A and B patients.


2019 ◽  
Vol 6 (4) ◽  
pp. 35-40
Author(s):  
Ali Dastjerdi ◽  
◽  
Omid Shahpari ◽  
Mahdi Mazloumi ◽  
Nafise Elahpour ◽  
...  

Background: Aneurysmal Bone Cysts (ABCs) are benign destructive tumors. Their diagnosis is sometimes challenging, and their treatment in unusual sites, especially in the pediatric age group is difficult, too. This study aims to support the paraclinical measures along proper consultation to approach the pelvic ABC. Methods: We present a 9-year-old female who suffered from pain in the left hip 3 months before the referral. A pelvic mass was diagnosed and unfortunately misdiagnosed with an ovarian mass. It was led to a wrong operation with a wrong approach by a general surgeon and result in intra-operative bleeding and delay in diagnosis and treatment. the final diagnosis was massive ABC in the supra-acetabular area with extension to the ilium and pubic. Conclusion: Pelvis is one of the most challenging sites for the diagnosis and treatment of bone tumors. Large ABC tumors in the hip are unusual and may be presented by non-specific signs and symptoms. Therefore complete clinical and radiological evaluations should be done before any attempt to surgically remove the pelvic mass. Prognosis is excellent if the pelvic mass remove wisely by an experienced hip surgeon


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