Cases reported "Chronic Disease"

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11/159. Chronic exposure keratopathy complicating surgical correction of ptosis in patients with chronic progressive external ophthalmoplegia.

    PURPOSE: To report chronic exposure keratopathy related to surgical ptosis correction in patients with chronic, progressive, external ophthalmoplegia. methods: case reports of three patients with chronic exposure keratopathy following blepharoptosis surgery. RESULTS: We report three patients with chronic progressive external ophthalmoplegia with chronic corneal complications after surgical ptosis repair. All three gave a history of blepharoptosis and extraocular muscle dysfunction. Each presented with chronic corneal ulceration. All had histories suggestive of ophthalmoplegia. Treatment of corneal ulceration necessitated hospitalization and surgical intervention. CONCLUSION: patients with chronic, progressive, external ophthalmoplegia have little ability to properly protect the eye from exposure and are at risk for corneal damage. A thorough ophthalmic history and examination before ptosis surgery may prevent the corneal complications resulting from surgical intervention.
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keywords = exposure
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12/159. A 65-year-old factory worker with dyspnea on exertion and a normal chest x-ray.

    Chronic beryllium disease is an occupationally acquired granulomatous lung disease similar to sarcoidosis. It is caused by exposure to beryllium in genetically susceptible persons. It should be suspected in patients with beryllium exposure who present with pulmonary symptoms or have a positive screening blood beryllium-specific lymphocyte proliferation test. The diagnosis is confirmed by the finding of granulomas on transbronchial biopsy in the appropriate clinical and epidemiologic setting. Although there is no cure, treatment with corticosteroids is usually beneficial. In view of the potential side effects, treatment is reserved for patients with symptoms or a decline in pulmonary function.
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ranking = 0.28571428571429
keywords = exposure
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13/159. Heme protein-induced chronic renal inflammation: suppressive effect of induced heme oxygenase-1.

    BACKGROUND: Heme oxygenase (HO) is the rate-limiting enzyme in the degradation of heme; its inducible isozyme, HO-1, protects against acute heme protein-induced nephrotoxicity and other forms of acute tissue injury. This study examines the induction of HO-1 in the kidney chronically inflamed by heme proteins and the functional significance of such an induction of HO-1. methods: Studies were undertaken in a patient with chronic tubulointerstitial disease in the setting of paroxysmal nocturnal hemoglobinuria (PNH), in a rat model of chronic tubulointerstitial nephropathy caused by repetitive exposure to heme proteins, and in genetically engineered mice deficient in HO-1 (HO-1 -/-) in which hemoglobin was repetitively administered. RESULTS: The kidney in PNH evinces robust induction of HO-1 in renal tubules in the setting of chronic inflammation. The heme protein-enriched urine from this patient, but not urine from a healthy control subject, induced expression of HO-1 in renal tubular epithelial cells (llc-pk1 cells). A similar induction of HO-1 and related findings are recapitulated in a rat model of chronic inflammation induced by repetitive exposure to heme proteins. Additionally, in the rat, the administration of heme proteins induces monocyte chemoattractant protein (MCP-1). The functional significance of HO-1 so induced was uncovered in the HO-1 knockout mouse: Repeated administration of hemoglobin to HO-1 / and HO-1 -/- mice led to intense interstitial cellular inflammation in HO-1 -/- mice accompanied by striking up-regulation of MCP-1 and activation of one of its stimulators, nuclear factor-kappaB (NF-kappaB). These findings were not observed in similarly treated HO-1 / mice or in vehicle-treated HO-1 -/- and HO-1 / mice. CONCLUSION: We conclude that up-regulation of HO-1 occurs in the kidney in humans and rats repetitively exposed to heme proteins. Such up-regulation represents an anti-inflammatory response since the genetic deficiency of HO-1 markedly increases activation of NF-kappaB, MCP-1 expression, and tubulointerstitial cellular inflammation.
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ranking = 0.28571428571429
keywords = exposure
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14/159. Chronic radiodermatitis after cardiac catheterization.

    A woman presented with a chronic radiodermatitis after a percutaneous transluminal coronary angioplasty (PTCA) for unstable angina. Two PTCAs had already been performed previously. Although rare, these chronic radiodermatitis have been described after multiple cardiac catheterization procedures as a result of cumulative X-ray exposure. Prevention must therefore be implemented.
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ranking = 0.14285714285714
keywords = exposure
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15/159. Radiological findings of accidental radiation injury of the fingers: a case report.

    This case report describes the medical follow-up of a 46-y-old (at the time of exposure) man who in 1971 accidentally exposed the fingers of his right hand to gamma-ray radiation from an iridium source that was used for nondestructive testing [estimated radiation dose: 26 Gy to 90 Gy (2,600 rad to 9,000 rad)]. No prominent acute injury was detected except for leukocytopenia (800 mm(-3)) and thrombocytopenia (15,000 mm(-3)). Three years later, the first, second, and third fingers presented repeated infection and started to develop contracture. Twenty-two years after exposure, he underwent amputation of the first and second fingers, and a toe graft was done. Radiological examinations prior to and following the operation revealed atrophic change of the finger bones and arterial injuries. Angiographic findings coincided with the region and extent of radiation injury of the fingers, which indicates that arterial damage is involved in the development of this chronic disorder.
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ranking = 0.28571428571429
keywords = exposure
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16/159. Possible estuary-associated syndrome: symptoms, vision, and treatment.

    The human illness designated as possible estuarine-associated syndrome (peas) by the Centers for disease Control and Prevention (CDC) has been associated with exposure to estuaries inhabited by toxin-forming dinoflagellates, including members of the fish-killing toxic Pfiesteria complex (TPC), pfiesteria piscicida and Pfiesteria shumwayae. humans may be exposed through direct contact with estuarine water or by inhalation of aerosolized or volatilized toxin(s). The five cases reported here demonstrate the full spectrum of symptoms experienced during acute and chronic stages of this suspected neurotoxin-mediated illness. The nonspecific symptoms most commonly reported are cough, secretory diarrhea, headache, fatigue, memory impairment, rash, difficulty in concentrating, light sensitivity, burning skin upon water contact, muscle ache, and abdominal pain. Less frequently encountered symptoms are upper airway obstruction, shortness of breath, confusion, red or tearing eyes, weakness, and vertigo. Some patients experience as few as four of these symptoms. The discovery that an indicator of visual pattern-detection ability, visual contrast sensitivity (VCS), is sharply reduced in affected individuals has provided an objective indicator that is useful in diagnosing and monitoring peas. VCS deficits are present in both acute and chronic peas, and VCS recovers during cholestyramine treatment coincident with symptom abatement. Although peas cannot yet be definitively associated with TPC exposure, resolution with cholestyramine treatment suggests a neurotoxin-mediated illness.
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ranking = 0.28571428571429
keywords = exposure
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17/159. Viral hepatitis? Which test should I order?

    BACKGROUND: There are a multitude of viruses that may cause hepatitis. The laboratory diagnosis of viral hepatitis is important in order to plan immediate patient management, determine treatment choices and provide patient education in order to limit transmission of infections to others. OBJECTIVE: This article outlines laboratory investigations that may be routinely ordered to assist in determining the etiology of viral hepatitis and summarises some preventive and treatment strategies that may be adopted. DISCUSSION: Investigations to determine exposure to infection are routinely performed and include simple serological tests, while tests to follow the course of infection or response to treatment may involve newer molecular techniques, including polymerase chain reaction (PCR), genotyping and viral quantification.
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ranking = 0.14285714285714
keywords = exposure
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18/159. Acute phase haemolysis in chronic cold agglutinin disease.

    We previously described a paradoxical form of chronic cold agglutinin disease (CAD) in which haemolysis occurred during episodes of fever but only marginally during exposure to colds. In order to investigate the molecular basis for this response we performed a 12-month prospective study of a patient with CAD and paradoxical haemolysis. blood samples were collected monthly during health, and daily following hospitalization owing to hip fracture. During health we observed decreased levels of C3, undetectable C4, a non-functional classical pathway and a normal alternative pathway. Increased concentrations of C1-INH/C1rs complexes indicated continuous formation of C1-antibody-antigen complexes. There was a low-grade temperature-dependent fluctuating haemolysis as evidenced from measurements of lactate dehydrogenase. Following the hip fracture, the haemolysis increased. Levels of interleukin (IL)-1beta, IL-6, interferon (IFN)-gamma and tumour necrosis factor (TNF)-alpha increased as did C1-INH, C3, C4, CRP, and lactate dehydrogenase. The results support our hypothesis stating that paradoxical haemolysis in CAD is controlled by the availability of early classical pathway complement molecules and that haemolysis following acute phase responses occurs as a consequence of increased complement synthesis.
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ranking = 0.14285714285714
keywords = exposure
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19/159. Pyogenic abscess of the filum terminale. Case report.

    Intradural spinal abscesses are rare. They are predominantly encountered as intramedullary abscesses of the spinal cord and infrequently as subdural lesions. To their knowledge, the authors report the first case of a chronic pyogenic abscess of the terminal filum in an adult woman with kyphoscoliosis who presented with lumbar radiculopathies. magnetic resonance imaging revealed a partly cystic intradural L3-4 mass that markedly enhanced after contrast administration. Laboratory signs of infection were absent. Intraoperatively a lobulated lesion observed within the terminal filum was tightly attached to neighboring nerve roots by fibrosis. On opening the cyst wall pus was revealed. Histological examination confirmed the diagnosis of a chronic abscess. Microbiological culture detected staphylococcus aureus. Antibiotic therapy resulted in an uneventful postoperative course, with complete resolution of symptoms and radiologically demonstrated disappearance of the lesion. The pathogenesis and radiological features of the lesion are discussed. Although extremely rare, a pyogenic abscess should be considered in the differential diagnosis of mass lesions of the cauda equina, especially in patients with preexisting spinal abnormalities. Surgical exposure, including drainage and biopsy sampling to rule out underlying tumor, combined with antibiotic treatment result in a favorable outcome.
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ranking = 0.14285714285714
keywords = exposure
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20/159. Chronic idiopathic acrocyanosis.

    Acrocyanosis is an uncommon condition characterized by symmetric coolness and violaceous discoloration of the hands and feet. The nose, ears, lips, and nipples are also often affected. The disease is temperature dependent and generally worsens with cold exposure. Acrocyanosis is often secondary to a variety of underlying causes. We present a very interesting case of a 44-year-old woman with almost lifelong idiopathic acrocyanosis. Differential diagnoses are discussed in this article.
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ranking = 0.14285714285714
keywords = exposure
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