Cases reported "Chronic Disease"

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1/47. Loss of resistance to methicillin and other antibiotics in staphylococcus aureus associated with a chronic empyema.

    A chronic empyema was investigated in a patient during a period of seven years. A strain of staphylococcus aureus resistant to methicillin and four other antibiotics was isolated and the loss of all these determinants was shown to occur in vitro. A similarly sensitive organism was obtained directly from the patient during the later stages of his illness and the homogeneity of the phage patterns indicate that the organism was a true variant which evolved from the highly resistant one.
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2/47. Approaching the patient with chronic malabsorption syndrome.

    The causes of chronic malabsorption may be categorized as decreased intestinal absorption, most commonly caused by celiac sprue; or maldigestion caused by pancreatic insufficiency. The initial step in the evaluation of these patients should include stool studies to confirm fat malabsorption. If fat malabsorption is confirmed, endoscopy with small-bowel biopsies and aspirates for bacterial culture usually follows. A normal endoscopic examination should lead to assessment of pancreatic function. In the setting of normal pancreatic function and the absence of bile acid deficiency, a barium radiograph of the small bowel should be made, looking for anatomical abnormalities. Celiac sprue is an intolerance to gluten caused by a combination of genetic, environmental, and immunologic factors. It classically causes malabsorption. However, it is likely that many patients who exhibit only minor manifestations of the disease go unrecognized and untreated. A presumed diagnosis of celiac sprue is confirmed after a clinical and endoscopic response to a gluten-free diet. Serological markers are available with high degrees of sensitivity and specificity, but duodenal biopsy remains the gold standard for diagnosis. A minority of patients are unresponsive to a gluten-free diet, and intestinal lymphoma should be suspected in these cases.
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ranking = 0.38049925361166
keywords = specificity
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3/47. Molecular basis and enzymatic properties of glucose 6-phosphate dehydrogenase volendam, leading to chronic nonspherocytic anemia, granulocyte dysfunction, and increased susceptibility to infections.

    We have investigated the blood cells from a woman with a low degree of chronic nonspherocytic hemolytic anemia and frequent bacterial infections accompanied by icterus and anemia. The activity of glucose 6-phosphate dehydrogenase (G6PD) in her red blood cells (RBCs) was below detection level, and in her leukocytes less than 3% of normal. In cultured skin fibroblasts, G6PD activity was approximately 15% of normal, with 4- to 5-fold increased Michaelis constant (Km) for nadp and for glucose 6-phosphate. Activated neutrophils showed a decreased respiratory burst. family studies showed normal G6PD activity in the RBCs from all family members, including both parents and the 2 daughters of the patient. Sequencing of polymerase chain reaction (PCR)-amplified genomic dna showed a novel, heterozygous 514C-->T mutation, predicting a Pro172-->Ser replacement. Analysis of G6PD rna from the patient's leukocytes and fibroblasts showed only transcripts with the 514C-->T mutation. This was explained by the pattern of X-chromosome inactivation, studied by means of the human androgen receptor (HUMARA) assay, which proved to be skewed in the patient, her mother, and one of the patient's daughters. Thus, the patient has inherited a de novo mutation in G6PD from her father and an X-chromosome inactivation determinant from her mother, causing exclusive expression of the mutated G6PD allele. Purified mutant protein from an escherichia coli expression system showed strongly decreased specific activity, increased Km for nadp and for glucose 6-phosphate, and increased heat lability, which indicates that the defective phenotype is due to 2 synergistic molecular dysfunctions: decreased catalytic efficiency and protein instability.
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4/47. Evans' syndrome complicating chronic graft versus host disease after cadaveric liver transplantation.

    Acute graft versus host disease (GVHD) occurred in a patient after cadaveric liver transplantation from an HLA disparate donor. immunosuppression resulted in a remission, but chronic GVHD with a scleroderma-like syndrome ensued. This was further complicated by immune hemolytic anemia and thrombocytopenia (Evan's syndrome). Semi-quantitative microsatellite analysis of circulating lymphoid cells showed that T cells were predominantly of donor origin, thereby explaining the chronic GVHD. The marrow hematopoietic cells remained recipient, so that the immune cytopenias were expected to be alloimmune in nature. However, the red cell antibodies were shown to have anti-C and anti-e specificity, with both the donor (R1R1) and recipient (R1r) possessing the C and e antigens. Therefore, the immune hemolysis might be considered both alloimmune and autoimmune. The patient finally died of sepsis. This case illustrates that chronic GVHD due to stable donor T cell engraftment may rarely occur in liver transplantation despite HLA disparity. immunosuppression may result in dysregulation of T cell functions, leading to alloimmune and autoimmune problems.
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ranking = 0.38049925361166
keywords = specificity
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5/47. Cardiac troponins: utility in renal insufficiency and end-stage renal disease.

    Currently available serum markers of cardiac injury in patients with renal insufficiency suffer from impaired sensitivity and specificity. Cardiac troponins (cTnI, cTnT) are relatively new diagnostic markers of myocardial injury and have gained widespread application in the non-renal-failure population to diagnose myocardial infarction. Over the past few years the specificity and sensitivity of cardiac troponins for diagnosing acute myocardial infarction in patients with renal dysfunction have been examined. Most data indicate that cardiac troponin i has an excellent specificity, but until more studies are available this marker should be considered a useful but imperfect serum marker of an acute coronary syndrome in patients with underlying renal dysfunction.
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ranking = 1.141497760835
keywords = specificity
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6/47. eponyms and the diagnosis of aortic regurgitation: what says the evidence?

    BACKGROUND: Chronic aortic regurgitation can lead to significant morbidity and mortality. For more than a century, numerous eponymous signs of aortic regurgitation have been described in textbooks and the literature. PURPOSE: To compare current textbook content with the peer-reviewed literature on the eponymous signs of aortic regurgitation and to assess the role of these signs in clinical practice. DATA SOURCES: 11 textbooks, medline (1966 through October 2002), and bibliographies of textbooks and relevant papers. STUDY SELECTION: English-language reports that were related to the properties of a sign on physical examination, incorporated more than 10 adults, and did not involve prosthetic heart valves or acute aortic regurgitation. DATA EXTRACTION: Three investigators independently analyzed relevant textbook extracts and 27 reports, using predetermined qualitative review criteria. Data relating to diagnostic accuracy and properties of the index test were also extracted. DATA SYNTHESIS: Twelve eponymous signs were described as having varying degrees of importance by textbook authors. Only the Austin Flint murmur, the Corrigan pulse, the Duroziez sign, and the Hill sign had sufficient original literature for detailed review. Most reports were low quality, with varying sensitivities for all signs. Except for the Hill sign, specificity tended to be poor. Evidence for the Hill sign also suggested a correlation between the popliteal-brachial gradient and aortic regurgitation severity. CONCLUSIONS: Prominent textbook support of the eponymous signs of aortic regurgitation is not matched by the literature. Clinicians and educators should update and improve the evidence for these signs to ensure their relevance in current medical practice.
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ranking = 0.38049925361166
keywords = specificity
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7/47. Differentiation of active and latent trigger points by thermography.

    OBJECTIVE: This study tested whether two distinct thermographic patterns attributed to myofascial trigger points could distinguish between active and latent trigger points. DESIGN: A retrospective chart survey was undertaken with thermographic data divided into two groups: a) increased thermal emission only over the trigger point and b) over the area of pain referral. The criterion standard used in a blinded comparison was physical examination findings separating active from latent trigger points. SETTING: All cases were drawn from a private practice referral center for thermographic evaluation of neck and low back injuries. patients: A sample of 65 cases showing physical examination findings of trigger points was chosen from 229 consecutive motor vehicle accident case files. RESULTS: There was moderate agreement between the two methods of differentiating active from latent latent trigger points (Kappa = 0.44) with a specificity of 0.70 and a sensitivity of 0.74. When cases in which spinal segmental dysfunction were eliminated, the agreement increased (Kappa = 0.54) with specificity of 0.82 and sensitivity of 0.74. CONCLUSIONS: thermography may be a useful tool in distinguishing active from latent trigger points, but the thermal imaging of spinal joint dysfunction may be a compounding factor.
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ranking = 0.76099850722332
keywords = specificity
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8/47. Development of lumbar high intensity zone on axial loaded magnetic resonance imaging.

    STUDY DESIGN: Case report. OBJECTIVES: To report the development of high intensity zones in the lumbar posterior anulus on axial loaded magnetic resonance imaging. SUMMARY OF BACKGROUND DATA: The high intensity zone is seen in the posterior anulus of degenerate lumbar discs on T2-weighted magnetic resonance images and represents a radial anular tear. Although the specificity of the high intensity zone for a concordantly painful anular tear in patients undergoing discography for discogenic low back pain is high, the sensitivity of magnetic resonance imaging for identification of discographically demonstrated anular tears is approximately 30%. methods: A 55-year-old female with chronic low back pain was imaged with lumbar spine magnetic resonance imaging before and following axial loading with an magnetic resonance imaging-compatible compression device. RESULTS: The nonloaded study demonstrated degeneration of the lower four lumbar discs. Following axial loading, posterior central high intensity zones were identified at the L2-L3 and L4-L5 levels. CONCLUSION: High intensity zones developed on axial loaded magnetic resonance imaging of the lumbar spine. We postulate that lumbar spine magnetic resonance imaging with axial loading may increase the sensitivity of magnetic resonance imaging for the detection of high intensity zones.
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ranking = 0.38049925361166
keywords = specificity
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9/47. A developmental perspective on the challenges of diabetes education and care during the young adult period.

    There is increasing recognition that the patient education and care provided to young adults with chronic physical illnesses, including type 1 diabetes, is inattentive to the complex developmental issues facing the older adolescent transitioning into the young adult period [pediatrics 110 (2002) 1307]. In this paper, we present a clinical perspective on the challenge of improving diabetes education and care during the young adult period focusing on the importance of the developmental changes-cognitive, social, emotional, educational, and familial-that occur during this transitional stage of life. This developmental perspective on young adulthood provides a conceptual framework to better understand the young adult's "readiness" for engagement in intensive medical therapy. We review factors such as the timing and context of diabetes care and education that may be important determinants of young adults' ultimate success in becoming independent managers of their health care during this difficult transition. Developmentally-based practice principles for the young adult period are presented which include: assessing the patient's expectation at transition, building the relationship, working with families, assessing barriers to care, and formulating treatment plans and goals.
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10/47. Chronic ectopic pregnancy diagnosed incidentally in an infertile woman: a case report.

    BACKGROUND: Chronic ectopic pregnancy is an enigma. The clinical presentation can be mild, with absent or subtle symptoms. The high incidence of negative pregnancy tests and the poor specificity of sonographic patterns can be misleading, and the correct diagnosis is sometimes established only at surgery or even histopathologically after the operation. We report the first case of a woman who was accidentally diagnosed with chronic ectopic pregnancy during diagnostic laparoscopy performed as part of a routine investigation for primary infertility. CASE: A 28-year-old woman underwent laparoscopyfor infertility. She had a regular menstrual cycle and was asymptomatic. She gave a history of a possible but unconfirmed miscarriage earlier. Her hormone profile was normal apart from a slightly raised prolactin level. An earlier ultrasound showed a polycystic appearance of the ovaries. laparoscopy was done on the 25th day of the menstrual cycle, and beta-human chorionic gonadotropin was negative. At laparoscopy, a 2-cm mass wasfound in the right fallopian tube. There was no free blood in the pelvis, and no adhesions. Both tubes were patent at hydrotubation. The mass was excised laparoscopically, and histology confirmed a diagnosis of chronic ectopic pregnancy. CONCLUSION: A review of articles on chronic ectopic pregnancy confirmed the difficulty in diagnosing this condition preoperatively.
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ranking = 0.38049925361166
keywords = specificity
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