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PubMed1996

Eosinophilic gastroenteritis.

Eosinophilic gastroenteritis is a rare condition of unknown etiology characterized by peripheral eosinophilia, eosinophilic infiltration of the gastrointestinal tract, and gastrointestinal symptomatology. Eosinophilic gastroenteritis is generally classified according to the layer of gastrointestinal tract involved. Mucosal involvement may result in abdominal pain, nausea, vomiting, diarrhea, weight loss, anemia, protein-losing enteropathy, and intestinal perforation. Patients with muscular layer disease generally have obstructive symptoms. Subserosal eosinophilic infiltration may result in development of eosinophilic ascites. Patients with mild and sporadic symptoms can be managed with reassurance and expectant observation. Patients with disabling symptoms can be effectively treated with corticosteroids after other systemic disorders associated with peripheral eosinophilia have been excluded. Occasionally, sodium cromolyn, ketotifen, and/or elimination diets have been shown to be effective in the management of patients who have a significant history of allergic disorder. Surgical intervention may be required in patients with obstructive complications or refractory disease.

Abdominal Pain↗
PubMed2004

Elderly patients with major depressive disorder and delusional disorder are at increased risk of subsequent dementia.

All the patients (n=150) admitted to psychogeriatric clinic during a 1-year period were followed up until their death or for 10 years. Fifteen of these were lost during the 10-year follow-up. Thus, follow-up data were available for 135 patients. Twenty-four of these fulfilled at baseline the DSM-III-R diagnostic criteria of major depressive disorder and 18 of delusional disorder after careful medical examination and neuropsychological tests to eliminate organic causes. In the follow-up, the diagnoses were gathered from the death certificates of those patients who died during the 10-year period and all of the patients alive at the end of the study were interviewed to assess their mental state. Six out of the 24 (25%) patients with major depressive and five out of 18 (28%) patients with delusional disorder developed clear organic dementia before death or within 10 years (mean follow-up time 6.7 years). This is approximately double the expected incidence in the general population of that age. The gender, age at index admission, the baseline Mini Mental State Examination scores or findings in computer tomography did not contribute to the risk of dementia. Psychogeriatric patients admitted due to major mental disorder may have an increased risk of organic dementia in the near future.

Aged↗
PubMed2004

Cytogenetic disorders in peripheral blood lymphocytes of patients with febrile form of tick-borne encephalitis.

An appreciable increase in the number of aberrant lymphocytes was detected in the peripheral blood of patients with febrile form of tick-borne encephalitis (TBE). This increase peaked during week 2 of the infectious process and was paralleled by a decrease in the count of natural killer cells. By the end of the acute period of neuroinfection the number of cells with structural chromosome aberrations decreased, but still surpassed the control (donor blood). Genetically unstable cells were eliminated predominantly at the expense of lymphocytes with chromatid disorders, while the count of CD16-expressing lymphocytes increased. The intensity of reparative DNA synthesis was suppressed during the entire acute period of tick-borne encephalitis.

Adult↗
PubMedDate not supplied

[The cytogenetic disorders in the people who took part in the cleanup of the sequelae at the Chernobyl Atomic Electric Power Station and who lived continuously in areas with an unfavorable ecological situation].

Cytogenetic disturbances are manifested now in persons who liquidated aftereffects of the Chernobyl disaster. The character and course of the disturbances depend on the ecological conditions of the region where liquidators live at present. Examination of a group of liquidators with nerve-psychopathologic disorders and accompanying somatic pathology has revealed the presence of cytogenetic disturbances, mainly of the chromosome aberration type. At the same time, in persons who live under conditions of high environment pollution with ejections of industrial enterprises, the number of chromatid aberrations increases, which may be a result of action of chemical mutagens. A tight correlation is revealed between the level of cytogenetic disorders in lymphocytes and expressivity of the secondary immunodeficiency. Elimination of lymphocytes with unstable chromosome aberration is delayed when ecological pollution of the biosphere reaches the high level.

Accidents↗
PubMed1980

Congenital defects of the central nervous system and occupational factors during pregnancy. A case-referent study.

The possible impact of occupational factors on the furtherance of congenital defects has been under study at our department for the past four years, and it has assumed a special interest because of the importance to understand the etiology of these disorders and a good possibility for prevention by elimination of the causative factor from the work environment. In connection with a register based case-referent study utilizing supplementary information, acquired by a single interviewer, we analyzed various occupational factors related to pregnancy. We found that organic solvent exposure and exposure to various dusts during the pregnant period were more common among the case mothers than among their matched referents. These findings may offer further rough guidance in the quest for the identification of possibly embryotoxic agents that may occur in occupational life.

Abnormalities, Drug-Induced↗
PubMed1999

[Severe lactic acidosis and thiamine deficiency during parenteral nutrition in a child].

We report the case of a leukemic child treated with chemotherapy and parenteral nutrition for three weeks, who developed a severe lactic acidosis. Clinical features included both digestive and neurological disorders associated with a moderate cardiovascular collapse. After elimination of a toxic, a neoplastic or a septic cause, a thiamin (or vitamin B1) deficiency was suspected because of the lack of vitamin supply to parenteral nutrition. Intravenous administration of thiamin rapidly controlled lactic and clinical features. The diagnosis was confirmed by a low plasmatic concentration of thiamin. Thiamin deficiency must be suspected in case of severe lactic acidosis during parenteral nutrition and systematically prevented by supply of vitamins.

Acidosis, Lactic↗
PubMed1996

The clinical significance of fever patterns.

The clinical validity of fever curves remains intact. Clinicians of old were not wrong in their astute observations. The diagnostic usefulness of fever curves is best applied to difficult-to-diagnose infectious diseases where present day investigations are relatively unhelpful. Fever patterns are particularly useful in eliminating diagnoses from consideration and suggesting otherwise unsuspected disorders that may be diagnosed by further procedures.

Fever↗
PubMed2004

Therapeutic manipulation of the enteric microflora in inflammatory bowel diseases: antibiotics, probiotics, and prebiotics.

Crohn's disease, ulcerative colitis, and pouchitis are caused by overly aggressive immune responses to a subset of commensal (nonpathogenic) enteric bacteria in genetically predisposed individuals. Clinical and experimental studies suggest that the relative balance of aggressive and protective bacterial species is altered in these disorders. Antibiotics can selectively decrease tissue invasion and eliminate aggressive bacterial species or globally decrease luminal and mucosal bacterial concentrations, depending on their spectrum of activity. Alternatively, administration of beneficial bacterial species (probiotics), poorly absorbed dietary oligosaccharides (prebiotics), or combined probiotics and prebiotics (synbiotics) can restore a predominance of beneficial Lactobacillus and Bifidobacterium species. Current clinical trials do not fulfill evidence-based criteria for using these agents in inflammatory bowel diseases (IBD), but multiple nonrigorous studies and widespread clinical experience suggest that metronidazole and/or ciprofloxacin can treat Crohn's colitis and ileocolitis (but not isolated ileal disease), perianal fistulae and pouchitis, whereas selected probiotic preparations prevent relapse of quiescent ulcerative colitis and relapsing pouchitis. These physiologic approaches offer considerable promise for treating IBD, but must be supported by rigorous controlled therapeutic trials that consider clinical disease before their widespread clinical acceptance. These agents likely will become an integral component of treating IBD in combination with traditional anti-inflammatory and immunosuppressive agents.

Anti-Bacterial Agents↗
PubMed1988

Bile acid metabolism in heterozygous familial hypercholesterolaemia: a study comparing affected and unaffected siblings of four kindreds.

Previous studies have indicated that quantitative as well as qualitative abnormalities of bile acid metabolism frequently occur in hypercholesterolaemia. In order to determine if this is a feature of familial hypercholesterolaemia, bile acid kinetics and biliary lipid composition were determined in 15 affected (heterozygous) and six unaffected siblings of four kindreds with familial hypercholesterolaemia. Furthermore, serum levels of cholic acid, chenodeoxycholic acid and deoxycholic acid were measured with a mass fragmentographic technique in 15 members of two of the kindreds, and secretion rates of biliary lipids were measured in six members of two kindreds. No differences with regard to these parameters between affected and unaffected siblings could be detected. There was a close resemblance between relatives of a given kindred concerning bile acid pool size and serum bile acid levels. No evidence for a defective bile acid metabolism in familial hypercholesterolaemia could be gained from the present study. It is concluded that the deficient receptor-mediated elimination of low density lipoprotein cholesterol in this disorder does not influence the maintenance of normal bile acid metabolism.

Adult↗
PubMed1992

Fat-suppressed MR imaging of myositis.

A hybrid fat-suppression sequence in magnetic resonance (MR) imaging was used to evaluate inflammatory muscle disorders in seven children: five patients with dermatomyositis, one patient with vasculitis, and one patient with viral myositis. Fat-suppressed multisection axial images obtained with the same repetition and echo times as those used to obtain standard spin-echo (SE) images enabled direct comparison of images, with little variation of T1 and T2 weighting. In six patients, the contrast on images obtained with T2 fat suppression was 15%-20% greater than contrast on conventional T2-weighted SE images. In all seven patients, the subjective judgment was that T2-weighted fat-suppression sequences improved visualization of muscle abnormalities. It is concluded that T2 fat suppression is useful in evaluation of inflammatory muscle disorders in children because it increases contrast and eliminates fat as a cause of muscle abnormality.

Child, Preschool↗
PubMed1999

Successful double lung transplantation with a graft obtained from a methanol-poisoned donor.

A 25-year-old woman developed "brain death" 48 h after acute methanol poisoning. After the elimination of methanol and the correction of metabolic disorders, organ donation was discussed. The lungs were transplanted into a 46-year-old woman suffering from cystic "emphysematous-like" lesions as a complication of lymphangioleiomyomatosis. The procedure was not complicated, and we have an uneventful follow-up of > 12 months. In addition to the lungs, the kidneys and the liver were also removed and transplanted with success.

Acute Disease↗
PubMed1999

Clinical pharmacology of new histamine H1 receptor antagonists.

The recently introduced H1 receptor antagonists ebastine, fexofenadine and mizolastine, and the relatively new H1 antagonists acrivastine, astemizole, azelastine, cetirizine, levocabastine and loratadine, are diverse in terms of chemical structure and clinical pharmacology, although they have similar efficacy in the treatment of patients with allergic disorders. Acrivastine is characterised by a short terminal elimination half-life (t1/2 beta) [1.7 hours] and an 8-hour duration of action. Astemizole and its metabolites, in contrast, have relatively long terminal t1/2 beta values; astemizole has a duration of action of at least 24 hours and is characterised by a long-lasting residual action after a short course of treatment. Azelastine, which has a half-life of approximately 22 hours, is primarily administered intranasally although an oral dosage formulation is used in some countries. Cetirizine is eliminated largely unchanged in the urine, has a terminal t1/2 beta of approximately 7 hours and a duration of action of at least 24 hours. Ebastine is extensively and rapidly metabolised to its active metabolite; carebastine, has a half-life of approximately 15 hours and duration of action of at least 24 hours. Fexofenadine, eliminated largely unchanged in the faeces and urine, has a terminal t1/2 beta of approximately 14 hours and duration of action of 24 hours, making it suitable for once or twice daily administration. Levocabastine has a terminal t1/2 beta of 35 to 40 hours regardless of the route of administration, but is only available as a topical application administered intranasally or ophthalmically in patients with allergic rhinoconjunctivitis. Loratadine is rapidly metabolised to an active metabolite descarboethoxyloratadine and has a 24-hour duration of action. Mizolastine has a terminal t1/2 beta of approximately 13 hours and duration of action of at least 24 hours. Most orally administered new H1 receptor antagonists are well absorbed and appear to be extensively distributed into body tissues; many are highly protein-bound. Most of the new H1 antagonists do not accumulate in tissues during repeated administration and have a residual action of less than 3 days after a short course has been completed. Tachyphylaxis, or loss of peripheral H1 receptor blocking activity during regular daily use, has not been found for any new H1 antagonist. Understanding the pharmacokinetics and pharmacodynamics of these new H1 antagonists provides the objective basis for selection of an appropriate dose and dosage interval and the rationale for modification in the dosage regimen that may be needed in special populations, including elderly patients, and those with hepatic dysfunction or renal dysfunction. The studies cited in this review provide the scientific foundation for using the new H1 antagonists with optimal effectiveness and safety.

Area Under Curve↗
PubMed2006

Minimally invasive surgery for esophageal achalasia.

Esophageal achalasia is the most commonly diagnosed primary esophageal motor disorder and the second most common functional esophageal disorder. Current therapy of achalasia is directed toward elimination of the outflow resistance caused by failure of the lower esophageal sphincter to relax completely upon swallowing. The advent of minimally invasive surgery has nearly replaced endoscopic pneumatic dilation as the first-line therapeutic approach. In this editorial, the rationale and the evidence supporting the use of laparoscopic Heller myotomy combined with fundoplication as a primary treatment of achalasia are reviewed.

Dilatation↗
PubMed2006

Identical TCR beta-chain rearrangements in streptococcal angina and skin lesions of patients with psoriasis vulgaris.

Tonsillar infection with Streptococcus pyogenes may induce several nonsuppurative autoimmune sequelae. The precise pathogenetic mechanisms behind this clinically well-established association are still unresolved. Using TCR analysis, we sought to identify a link between streptococcal tonsillitis and the T cell-mediated autoimmune response in psoriasis. Three patients with streptococcal-induced psoriasis underwent tonsillectomy. Using size spectratyping and sequencing of TCR beta-chain variable region gene (TCRBV) rearrangements, we compared the TCR usage of psoriatic skin lesions, blood, tonsils, and tonsillar T cells fractionated according to the expression of the skin address in "cutaneous lymphocyte-associated Ag" (CLA). TCRBV-size spectratype analysis of the blood lymphocytes, tonsils, and the CLA-negative tonsillar T cells revealed largely unselected T cell populations. Instead, TCRBV gene families of the psoriatic lesions and skin-homing CLA-positive tonsillar T cells displayed highly restricted spectratypes. Sequencing of TCRBV cDNA identified various clonal TCRBV rearrangements within the psoriatic lesions that indicated Ag-driven T cell expansion. Several of these clonotypes were also detected within the tonsils and, in one of the patients, within the small subset of CLA-positive tonsillar T cells, suggesting that T cells from the same T cell clones were simultaneously present within skin and tonsillar tissue. Because after tonsillectomy psoriasis cleared in all three patients our observations indicate that T cells may connect psoriatic inflammation to streptococcal angina. They suggest that the chronic streptococcal immune stimulus within the tonsils could act as a source for pathogenic T cells in poststreptococcal disorders, and they may help to explain why eliminating this source with tonsillectomy may improve streptococcal-induced sequelae.

Adult↗
PubMed1999

[Hormone replacement therapy in the prevention of osteoporosis. Evolution of therapeutic methods].

ESTABLISHED FACTS: Many studies have evidenced that hormone replacement therapy can help prevent post-menopausal osteoporosis and osteoporotic fractures in menopaused women. Thanks to recent advances in pharmacology, hormone replacement therapy can now closely mimic ovarian physiology and thus eliminate most of the contraindications related to metabolic disorders. UNRESOLVED QUESTIONS: The need for prolonged treatment to reach optimal efficacy raises the problems of safety and compliance. This is particularly true for the prevention of fractures of the femoral neck which usually occur in older women, suggesting it could be useful to revisit the estrogen strategy. NEW COMPOUNDS: The action of selective estrogen receptor modulators (SERM) depends on the target organ. They have an estrogen agonist effect on bone and lipid metabolism but no such effect on the uterus. SERMs could offer new therapeutic opportunities for the prevention of post-menopausal osteoporosis.

Adolescent↗
PubMedDate not supplied

Small intestinal brush border enzymes in cystic fibrosis.

The study concerns the maltase, saccharase, lactase and alkaline phosphatase activity in small intestinal biopsy specimens from 61 consecutively admitted, untreated, Caucasian cystic fibrosis patients. A group of 319 age matched controls admitted during the same time period for undefined gastrointestinal or nutritional disorders acted as the controls. In order to eliminate morphological damage as a confounding factor, the enzyme activities were studied in small intestinal biopsy specimens having both normal stereomicroscopic and histological features. It was shown that neither maltase nor saccharase activity was different in the two groups, in contrast to lactase and alkaline phophatase activity, that was significantly lower in cystic fibrosis patients. The differences could not be explained by the nutritional status as judged by the body mass index. Lactase activity is known to be easily affected by numerous enteropathies. As the information on alkaline phosphatase activity is limited, the low activity is discussed in more detail. Taking into account the literature data, the low alkaline phosphatase activity is tentatively attributed either to enhanced release from the brush border or to the faulty handling of alkaline phophatase protein in the post-golgi compartments secondary to the accumulation of incorrectly glycosylated CFTR in the same cell structures.

Alkaline Phosphatase↗