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Zeitschriftendaten
Format
Zeitschrift
eISSN
1875-855X
Erstveröffentlichung
01 Jun 2007
Erscheinungsweise
6 Hefte pro Jahr
Sprachen
Englisch

Suche

Volumen 7 (2013): Heft 5 (October 2013)

Zeitschriftendaten
Format
Zeitschrift
eISSN
1875-855X
Erstveröffentlichung
01 Jun 2007
Erscheinungsweise
6 Hefte pro Jahr
Sprachen
Englisch

Suche

17 Artikel

Editorial

Uneingeschränkter Zugang

Chronic viral hepatitis: a need for a comprehensive approach

Online veröffentlicht: 04 Feb 2017
Seitenbereich: 597 - 598

Zusammenfassung

Original article

Uneingeschränkter Zugang

Natural history, outcome, and sustainability of treatment response in chronic viral hepatitis B: Thai multicenter study

Online veröffentlicht: 04 Feb 2017
Seitenbereich: 599 - 607

Zusammenfassung

Abstract

Background: Data regarding the natural history and outcome of treatment of chronic hepatitis B (CHB) patients in Thailand remain inconclusive.

Objective: We aimed to examine the natural history and outcome of therapy in Thai CHB patients treated with nucleoside analogues (NAs) monotherapy or interferon (IFN) monotherapy.

Method: CHB patients without clinical evidence of cirrhosis and alanine aminotransferase (ALT) levels >1.5 times of normal for at least 6 months were enrolled from 6 hospitals (2002 to 2005). Treatment included NAs and IFN. Treatment response was defined as ALT normalization and an HBV DNA level <10,000 copies/ml (or <2,000 IU/ml) and/or HBeAg seroconversion at the end of follow up. The study was approved by the institutional review board of each hospital.

Result: A total of 567 patients with mean age of 46.8 ± 11.9 y were included. The ratio of HBeAg positive to HBeAg negative patients was 1.3:1. Nineteen percent of patients had no HBeAg status. There were 262 HBeAg positive patients (46%) and 197 HBeAg negative patients 35%. Sixty-one percent received NAs while 20% received IFN as a first line treatment and the remaining 19% received no specific medication. For the HBeAg positive patients, HBeAg seroconversion and undetectable HBV-DNA were achieved in 32.8% and 50.5%, respectively in NAs group (on therapy), and HBeAg seroconversion and undetectable HBV-DNA were achieved in 24.3% and 21.4%, respectively in the IFN-treated group (off treatment). For the HBeAg negative patients, undetectable levels of HBV-DNA occurred in 68.8% in the NAs group while undetectable levels of HBV-DNA occurred in 37.5% of patients in the IFN-treated group. HBsAg loss was not found in the NAs group, but 2.8% of patients in IFN group had HBsAg loss. HBV DNA reappeared in the IFN group (off treatment) and NAs groups (on therapy) in 26.6% and 24.3% of patients, respectively. Minor adverse events of therapy were found in 9% of patients. Five percent of patients progressed to Child A cirrhosis and one patient in the NAs group (0.18%) died from causes unrelated to liver disease, during a 3-year follow-up.

Conclusion: The treatment response of Thai CHB patients from multicenter study showed the results similar to previous studies. However, higher durability of treatment with lower rate of reappearance of HBV DNA was observed in Thai CHB patients.

Schlüsselwörter

  • Chronic hepatitis B
  • Thai
  • multicenter study
  • natural history
  • outcome of treatment
Uneingeschränkter Zugang

Diagnostic accuracy of liver stiffness measurement and serum hyaluronic acid for detecting liver fibrosis in chronic hepatitis B with respect to ALT levels

Online veröffentlicht: 04 Feb 2017
Seitenbereich: 609 - 617

Zusammenfassung

Abstract

Background: The assessment of liver fibrosis in chronic hepatitis B is crucial in clinical practice.

Objective: We compared the diagnostic accuracy of liver stiffness measurement (LSM) using transient elastography and serum hyaluronic acid (HA) in detecting liver fibrosis (METAVIR) in chronic hepatitis B, with respect to ALT levels.

Method: One hundred fifty-six Thai patients with chronic hepatitis B who had undergone a liver biopsy were enrolled, and included 112 (71.8%) men and 44 (28.2%) women. The mean age of the patients was 40.1±12.2 years. The predictive accuracy was analyzed by comparing the areas under the receiver-operating characteristic curves (AUROCs).

Result: LSM was superior to HA in predicting fibrosis stages of ≥F2 (AUROCs were 0.820 vs 0.727, p=0.009), ≥ F3 (0.910 vs 0.848, p=0.015) and F4 (0.938 vs 0.876, p=0.031). There was significant correlation between ALT level and LSM value, while such correlation between ALT and HA was not detected. Regarding the subgroup of patients with ALT levels >80 IU/L (2 × ULN), AUROCs of LSM and HA for predicting fibrosis stages of ≥F2 (0.733 vs 0.696), ≥F3 (0.892 vs 0.844) and F4 (0.934 vs 0.893) were not significantly different.

Conclusion: LSM was superior to HA in predicting liver fibrosis and cirrhosis in patients with chronic hepatitis B. However, in patients with ALT elevation, the diagnostic performance of LSM was reduced and its accuracy was comparable to that of HA. Thus, HA could be an alternative method in assessing liver fibrosis in patients with high ALT levels.

Schlüsselwörter

  • ALT level
  • AUROC
  • cirrhosis
  • diagnostic accuracy
  • hepatitis B
  • hyaluronic acid
  • liver stiffness
  • transient elastography
Uneingeschränkter Zugang

Prevalence of hepatitis B and hepatitis C in patients referred to health centers in the Hamadan province, Iran: an epidemiologic study of infections between 2004 and 2007

Online veröffentlicht: 04 Feb 2017
Seitenbereich: 619 - 625

Zusammenfassung

Abstract

Backgroud: Hepatitis B virus (HBV) and Hepatitis C virus (HCV) are the main causes of liver related morbidity and mortality.

Objective: To assess the epidemiologic features of HBV and HCV infections between 2004 and 2007 in the Hamadan province, Iran.

Methods: In a cross-sectional study, epidemiologic and demographic characteristics of patients infected with HBV or HCV, or both, during about four years were collected from health centers in the Hamadan province.

Results: Overall, there were 1533 infected patients (66.2% with HBV, 32.5% with HCV, and 1.3% with both). Male patients comprised 74.4% of patients. In view of marital status, 71.3% were married, 27% single, and 1.7% were widowed or divorced. The majority of patients (78.4%) inhabited urban areas while 21.6% inhabited rural areas. Patients <4 years old had the lowest rate of infection (0.26%), while the highest incidence (13.11%) was found in the 25-29-year-old age range. With respect to serologic markers, 61.4%, 33.7%, 4.4% and 0.3% of patients were HBsAg+, HCVAb+, HBsAb+ and HBeAg+, respectively. Overall, the incidence of HBV was found to be decreased from 2004 to 2007, while the incidence of HCV increased from 2004 to 2007.

Conclusion: The prevalence of HBV infection decreased during the period of study. This could be attributed to the increasing public vaccination of neonates and people at high-risk, which began about 15 years ago. However, it seems that an increasing incidence of high-risk behaviors including intravenous drug abuse with shared syringes has led to an increased incidence of HCV infection.

Schlüsselwörter

  • Epidemiology
  • health center
  • hepatitis B virus
  • hepatitis C virus
  • prevalence
Uneingeschränkter Zugang

The expression and significance of FOXO3a and Jab1 in human ovarian cancer

Online veröffentlicht: 04 Feb 2017
Seitenbereich: 627 - 634

Zusammenfassung

Abstract

Background: Ovarian carcinoma represents one of the most insidious and aggressive cancers. Ovarian carcinoma is the most lethal gynecological malignancy. To discover new relevant biomarkers to increase specificity and sensitivity for early diagnosis and prognosis of ovarian cancer is important and urgently needed. FOXO3a possesses a large series function including cellular proliferation, transformation, differentiation, and longevity. Jab1 is also known as subunit 5 (CSN5) of the COP9 signalosome (CSN), a multifunctional protein complex involved in modulating signal transduction, gene transcription, and protein stability.

Objective: To investigate the importance of FOXO3a and Jab1 in ovarian cancer.

Method: Immunohistochemical analysis was performed on formalin-fixed paraffin sections of 46 specimens. Statistical analysis was conducted using the Stat View 5.0 software package.

Result: We found that Foxo3a expression correlates significantly with FIGO disease stage (p < 0.05) and lymph node involvement. Jab1 expression correlates significantly with disease stage and lymph node involvement (p < 0.05). A multivariate Cox proportional hazard model showed that Foxo3a and Jab1 were the strongest independent predictors of survival (p < 0.05), the second predictor being FIGO disease stage and lymph node involvement.

Conclusion: Understanding the precise role of Jab1 and Foxo3a in ovarian cancer progression will not only increase our knowledge of the biology of ovarian cancer but may also enable development of an novel therapeutic strategy via suppression of Jab1.

Schlüsselwörter

  • Jab1
  • FOXO3a
  • ovarian cancer
  • prognosis
  • proliferation
Uneingeschränkter Zugang

Hemiarthroplasty versus total hip arthroplasty for displaced femoral neck fractures: a meta-analysis of the literature

Online veröffentlicht: 04 Feb 2017
Seitenbereich: 635 - 647

Zusammenfassung

Abstract

Background: Hemiarthroplasty and total hip arthroplasty are the two most common methods for displaced femoral neck fracture. However, the efficacy of the two methods is still controversial and needs a comprehensive analysis.

Objective: This meta-analysis was to investigate whether total hip arthroplasty (THA) is associated with lower reoperation rate, mortality, complications, better function and quality of life than hemiarthroplasty (HA) for patients with displaced femoral neck fractures.

Materials and Methods: Thirty-one trials involving a total of 4324 patients were included. Six randomized controlled trials, 8 lower-quality randomized trials, and 17 retrospective cohort studies comparing HA with THA for displaced femoral neck fractures were assessed for eligibility. Incidence rate and risk ratios (RR) were pooled using random-effects or fixed-effects models depending on the heterogeneity of included studies.

Results: Meta-analysis showed that THA was associated with a lower risk of reoperation (incidence rate 2.8%, 95%CI 1.8%-3.8%) compared with HA (incidence rate 7.4%, 95%CI 5.3%-9.6%) (RR = 0.42, 95%CI 0.30-0.58, P < 0.001) and higher excellent and good rate by Harris hip score (RR = 1.12, 95%CI 1.06-1.19, P < 0.001). There was a tendency of better prognosis in patients undergoing THA (RRmortality = 0.82, 95%CI 0.67-1.01), but it was not statistically significant (P = 0.067). However, there was a higher risk of dislocation in patients undergoing THA (incidence rate 4.2%, 95%CI 2.7%-5.8%) compared with HA (incidence rate 2.3%, 95%CI 1.4%-3.2%) (RR = 1.79, 95%CI 1.24-2.57, P = 0.002), but there was no difference in both local infections and general complications (P = 0.201 and P = 0.712).

Conclusion: THA can benefit patients of displaced femoral neck fractures with a reduced reoperation rate and better hip function, though it can result a higher incidence of postoperative dislocation. The impact of different hip arthroplasty on prognosis need further studies.

Schlüsselwörter

  • Displaced femoral neck fractures
  • hemiarthroplasty
  • total hip arthroplasty
Uneingeschränkter Zugang

Vitamin E reduces sensory neuronal loss and improves nerve regeneration after sciatic nerve injury

Online veröffentlicht: 04 Feb 2017
Seitenbereich: 649 - 655

Zusammenfassung

Abstract

Background: Nerve injury results in axonal degeneration and loss of sensory neurons in dorsal root ganglia (DRG). Enhanced oxidative stress was also observed following injury, suggesting potential efficacy of antioxidant therapy.

Objective: To examine the effects of vitamin E on nerve regeneration after nerve injury in rats.

Method: Unilateral sciatic nerve crush was performed on rats which were divided into three groups: control and 2 doses of vitamin E. The control group received only vehicle (corn oil) and vitamin E groups received α-tocopherol 500 and 1,000 mg/kg/day once daily by gavage. Regeneration was evaluated at 10 days post-injury. In a second experiment, there were two groups, vehicle and vitamin E 500 mg/kg/day, and the regeneration duration was extended to 3 weeks.

Result: The first experiment showed that vitamin E 500 and 1,000 mg/kg/day could significantly reduce DRG neuronal loss from 31.5% in the control group to 17.1% and 13.5%. However, the regeneration distances were not significantly different among groups. In the second experiment, although vitamin E 500 mg/kg/day significantly increased the plasma vitamin E level, motor recovery of the hind limb, as assessed by walking track analysis, was not significantly improved. By contrast, nerve morphometry revealed increased density and number of myelinated fiber after vitamin E treatment.

Conclusion: Vitamin E may be beneficial to sensory neuronal loss and nerve regeneration after nerve trauma

Schlüsselwörter

  • Nerve injury
  • nerve regeneration
  • neuronal loss
  • vitamin E
  • α-tocopherol
Uneingeschränkter Zugang

Phase I study of integrating PET/CT and dose-escalated intensity modulated radiation therapy using a simultaneous integrated boost technique for thoracic esophageal cancer

Online veröffentlicht: 04 Feb 2017
Seitenbereich: 657 - 667

Zusammenfassung

Abstract

Background: Esophageal cancer has a poor prognosis because most patients have locally advanced disease upon presentation, and are therefore not suitable for upfront surgery. Modern radiation therapy techniques using intensity modulated radiation therapy (IMRT) combined with a novel imaging technique using integrated positron emission tomography and computed tomography (PET/CT) may help radiation oncologists increase radiation dose to the tumor and may improve tumor response.

Objective: The primary aim was to analyze the toxicity of dose-escalated IMRT using a simultaneous integrated boost (SIB) technique and concurrent chemotherapy in esophageal cancer patients using PET/CT as a guide for target delineation. Secondary endpoints were to evaluate response rate, overall survival, and event-free survival rates.

Method: Seventeen consecutive patients with locally advanced carcinoma of the esophagus were treated with preoperative concurrent chemoradiation that consisted of IMRT 64 Gy in 30 fractions (SIB technique), together with two cycles of cisplatin (80 mg/m2, day 1 and 29) and 5-fluorouracil (1000 mg/m2/d, days 1-4 and 29-32). Baseline PET/CT was used for staging and target delineation. After complete chemoradiation for 3 months, PET/CT was repeated and the patients were evaluated for esophagectomy. Treatment toxicities were collected. Baseline and 3-month postchemoradiation PET/CT imaging were analyzed and correlated with the pathological findings.

Result: The median follow-up time was 12 months. All 17 patients had squamous cell carcinoma of thoracic esophageal cancer and were treated with chemoradiation. The most common acute ≥grade 3 adverse effects were leucopenia (58.8) and vomiting (23.5%), respectively. Acute ≥grade 3 cardiotoxicities and pulmonary toxicities were observed in 5.9% and 11.7% of the patients, respectively. One patient (5.9%) died from an esophagopericardial fistula. Seven patients underwent esophagectomy after chemoradiation. A pathologic complete remission was achieved in 4 patients (57.1% of the surgical group or 23.5% of the entire group). The overall 1-year survival and event free survival rates for the entire group of patients were 87% and 59%, respectively. There was a statistically significant difference in the overall 1-year survival between surgical and nonsurgical groups (overall 1-year survival, 100% versus 74%, respectively, p = 0.037). In contrast, there was no significant difference in 1-year event-free survival between groups (1-year event-free survival, 72% versus 56%, p = 0.085). Applying the average absolute reduction and percentage reduction of SUVmax in these patients, PET/ CT could not predict the pathologic response.

Conclusion: Integrating PET/CT for dose-escalated IMRT in esophageal cancer patients showed acceptable toxicities and promising overall survival, especially when followed by surgery.

Schlüsselwörter

  • Chemoradiation
  • esophageal cancer
  • intensity modulated radiation therapy (IMRT)
  • positron emission tomography/computed tomography (PET/CT)
  • simultaneous integrated boost
  • target delineation
Uneingeschränkter Zugang

Effects of a daytime nap on the recognition of neutral and emotional memories

Online veröffentlicht: 04 Feb 2017
Seitenbereich: 669 - 679

Zusammenfassung

Abstract

Background: Memory can be facilitated by the emotional strength of encoded information. Offline consolidation during sleep (post-learning sleep, even as little as a nap,) also modulates declarative memory processing. Previous studies have investigated the influence of sleep, especially rapid eye movement (REM) sleep, on emotional memory facilitation in humans. However, the interaction between emotional valence asymmetry and nap-dependent memory consolidation is poorly understood.

Objective: To investigate the effects of post-learning nap on the recognition of neutral and emotional memories.

Method: Ten healthy male participants completed a study session involving 240 emotional (negative and positive stimuli with different arousal magnitudes) and neutral pictures of people, animals, objects, and landscapes. Participants were then immediately tested on the visual recognition performance, in which they need to make recognition judgments on a subset of previously seen (“old”) pictures and intermixed unseen (“new”) pictures containing similar emotional and semantic contents. Three hours after this initial baseline test, one-half of the participants obtained a 90-minute nap opportunity, recorded with electroencephalography (EEG), whereas the others remained awake. Participants were again tested on the remaining “old” and “new” pictures at 6 hours after learning session.

Results: The results revealed a beneficial effect of delayed post-learning nap on the recognition of neutral declarative memory. The extent of neutral memory facilitation was negatively correlated with the amount of stages-2 NREM. Unlike previous studies, the recognition performance for negative emotional items with high arousal condition in the Nap group deteriorated across an offline time rich in stage-2 NREM sleep. However, both groups showed similar decrease in recognition accuracy for positive stimuli.

Conclusion: Our findings suggest that declarative memories containing distinct emotional valence and arousal are consolidated differentially during wakefulness and sleep. Under certain conditions, a daytime nap rich in stage-2 NREM sleep may play an important role on these performance differences.

Schlüsselwörter

  • EEG
  • emotion
  • nap
  • NREM
  • recognition memory

Brief communication (Original)

Uneingeschränkter Zugang

The frequency of Chlamydia trachomatis and Neisseria gonorrhoeae infections among women in Kermanshah, Iran

Online veröffentlicht: 04 Feb 2017
Seitenbereich: 681 - 685

Zusammenfassung

Abstract

Background: Sexually transmitted diseases (STDs) are a major health problem in various societies. Chlamydia trachomatis and Neisseria gonorrhoeae are among the most important bacterial causes. Molecular techniques have been used for detection of these pathogens with high sensitivity and specificity.

Objective: We studied the frequency of C. trachomatis and N. gonorrhoeae in women with cervicitis in Kermanshah City.

Method: A total of 255 married women with cervicitis referred to Kermanshah’s clinics were randomly included in this study. Endocervical samples were collected using Dacron swabs and sent to the laboratory in phosphate buffered saline. The clinical symptoms of women were recorded. Samples were tested with specific primers for C. trachomatis and N. gonorrhoeae using a multiplex PCR technique.

Results: Among 255 cases, 14 (5.5%) showed bacterial infections. C. trachomatis were detected in 8 (3.1%) samples and N. gonorrhoeae were detected in 6 (2.4%) samples. The rate of infection was higher in women under the age of 25 years. There was no case of simultaneous infection for both bacteria.

Conclusion: This study indicated that the incidence of infection with C. trachomatis and N. gonorrhoeae in Kermanshah is relatively low, which is consistent with the results of other studies in Middle East.

Schlüsselwörter

  • Chlamydia trachomatis
  • infection
  • Neisseria gonorrhoeae
  • women
Uneingeschränkter Zugang

Phylogenetic analysis of VP1 region of CA16 isolated from children with severe hand-foot-mouth disease

Online veröffentlicht: 04 Feb 2017
Seitenbereich: 687 - 693

Zusammenfassung

Abstract

Background: CA16 and enterovirus 71 are two key etiological agents for children’s hand-foot-mouth disease (HFMD). Large-scale HFMD outbreaks have taken place every year in Liaocheng City, Shandong Province of China since 2008.

Objective: We investigated the genetic background and phyletic evolution of coxsackie virus A16 (CA16)-related severe HFMD in children from Liaocheng City.

Method: CA16 was screened from throat swab and anus specimens obtained from children with severe HFMD between 2008 and 2010. Specific primers were used to amplify the VP1 region of CA 16 for sequence analysis.

Result: A total of 461 specimens were detected to be enterovirus positive from 2008 to 2010 and 401 specimens were CA16 positive. The nucleotide and amino acid sequences of 16 isolates from children with severe HFMD were compared with the reference sequences, and the nucleotide homology was 91.43%-98.65%, and the amino acid homology was 97.98%-100%. Of the16 isolates, 9 isolates and BJ03-ZDP (AY821798), Shzh00-1 (AY790926), Shzh05-1 (EU262658), and GZ08 (FJ198212) strains isolated from Chinese mainland were located on the same branch; the remaining 7 isolates, the strains isolated from Malaysia, Thailand, Vietnam, Australia and other neighboring countries. AF177911 from Taiwan andshzh01-69 strain (AY895111) from Shenzhen were located on another branch.

Conclusion: CA16 is one of the major pathogens of HFMD and the homology of strains is high.

Schlüsselwörter

  • Coxsackie virus A16
  • enterovirus
  • hand-foot-mouth disease
Uneingeschränkter Zugang

Organ doses, effective dose, and radiation risk assessment in radiography of pediatric paranasal sinuses (Waters view)

Online veröffentlicht: 04 Feb 2017
Seitenbereich: 695 - 698

Zusammenfassung

Abstract

Background: For diagnosis of acute sinusitis, conventional radiography is the investigative method of choice. While radiological examinations undoubtedly help in the proper diagnosis of various diseases, their excessive use can lead to unnecessary exposure to radiation, the biggest long-term risk of which is cancer. Awareness of effective dose and radiation risk from the radiological procedure is necessary for taking decisions about executing an X- ray examination.

Objective: We evaluated organ doses, effective doses (E), and the corresponding risk of exposure-induced cancer death resulting from paranasal sinus radiography for male and female patients in all age groups.

Materials ad Method: The radiographic technique variables used for this examination of ‘standard patients’ of six different ages (newborn, 1, 5, 10, 15-year-old, and adult) were obtained from the departments of radiology of seven public hospitals in Yazd city. PCXMC software was used to simulate projections and calculate the resulting organ and effective doses from these projections. The program also calculated the risk of death for radiationinduced cancers.

Result: For the six age groups, mean effective doses (E) were found to be 20.34, 22.52, 24.52, 25.96, 31.82 and 39.81 μSv, respectively. For male and female patients, the corresponding risk ranges were 1.14-2.59 and 1.31- 3.22 per million, respectively.

Conclusion: Results of this study can be used as a guide by physicians to conduct a risk-benefit analysis to justify radiographic assessment of paranasal sinuses before it is requested; especially for children.

Schlüsselwörter

  • Paranasal sinuses
  • pediatric
  • radiation-induced cancer
  • radiography
Uneingeschränkter Zugang

Surviving acquired severe nonmalignant hemophagocytic syndrome

Online veröffentlicht: 04 Feb 2017
Seitenbereich: 699 - 704

Zusammenfassung

Abstract

Background: Hemophagocytic syndrome (HPCS) is not rare in Thailand. At present the outcome in severe cases is often unsatisfactory because of a delay in diagnosis and improper management. From 1999 to 2011, the authors have gained experience in the management of severe acquired nonmalignant HPCS in Thai adult patients. From 1999 to 2003, three out of 10 patients died. During 2005-2011, seven patients with severe HPCS survived. This improvement stimulated the authors to analyze clinical manifestations, etiology, and management of these patients.

Objective: To find the keys to successful outcomes in the management of acquired severe nonmalignant HPCS in seven survivors during 2005-2011. To alert physicians that acquired severe nonmalignant HPCS may be cured.

Materials and Methods: The records of ten patients with HPCS were analyzed. Between 1999 and 2003 three patients died. Between 2005 and 2011 seven patients survived.

Results: The three patients during 1991-2003 may well have died because of delayed diagnosis and improper management. One case of HPCS was diagnosed after death. In the other two cases etiologies were not readily identified and dealt with. In the surviving group, treatment was started as soon as HPCS was suspected or diagnosed. This consisted of removal of any known cause and aggressive management of associated conditions and complications.

Conclusion: Adults who acquire severe nonmalignant HPCS can be treated successfully. The key roles for this success are early diagnosis and appropriate management. The best supportive care and close observation by the team of hematologists and physicians also determines patient survival.

Schlüsselwörter

  • Therapy
  • acquired severe nonmalignant hemophagocytic syndrome

Clinical report

Uneingeschränkter Zugang

Delayed cerebral ischemia after clipping of middle cerebral artery aneurysms

Online veröffentlicht: 04 Feb 2017
Seitenbereich: 705 - 709

Zusammenfassung

Abstract

Background: Delayed cerebral ischemia (DCI) that occurs more than 14 days after clipping of middle cerebral artery (MCA) aneurysms is rare.

Objective:To investigate whether multiple treatments that prevent vasospasms and microthrombosis may achieve a better outcome for DCI.

Method: We present three cases of subarachnoid hemorrhage (SAH) in patients who experienced DCI before and after MCA aneurysmal clipping. Their clinical manifestations, neuroradiological aspects, treatment, and outcomes are presented. Digital subtraction angiograms and computed tomographic angiography were performed to confirm the MCA aneurysms. Aneurysmal clippings were implemented via a pterional approach within 3 days of the onset of SAH. Triple-H therapy was conducted, and nimodipine was administered intravenously. The three patients were released with intact neurological status within 14 days to 17 days of clipping.

Results: The three patients were readmitted within 7 days after discharge because of cerebral ischemia in the corresponding MCA area. Antiplatelet drugs were administered with resolution of clinical symptoms within a few days.

Conclusion: The occurrence of this kind of DCI is rare. The pathogenesis of DCI is unknown and may be complex. Multiple treatments that prevent vasospasms as well as microthrombosis may achieve a better outcome.

Schlüsselwörter

  • Aneurysm clipping
  • delayed cerebral ischemia
  • micro-thrombosis
  • middle cerebral artery
Uneingeschränkter Zugang

Mesenteric venous thrombosis in a patient with antiphospholipid syndrome and systemic lupus erythematosus

Online veröffentlicht: 04 Feb 2017
Seitenbereich: 711 - 714

Zusammenfassung

Abstract

Background: Antiphospholipid antibodies (aPL) are associated with an increased risk of venous thrombosis and can occur in patients without any associated conditions, or in those with autoimmune disorders, such as systemic lupus erythematosus (SLE). Mesenteric venous thrombosis (MVT) is one of the clinical manifestations of antiphospholipid syndrome (APS), and it has rarely been reported in patients with SLE.

Objective: To report a case of SLE complicated by APS and MVT.

Method: A 28-year-old woman with a history of SLE and lupus nephritis was admitted with nonspecific abdominal symptoms. The working diagnosis was severe SLE and paralytic ileus because of primary peritonitis.

Result: Nine days after she did not respond to symptomatic treatment, exploratory laparotomy revealed MVT and further coagulation work-up was diagnostic for APS. Despite treatment, she died because of complications of SLE and APS.

Conclusion: Though rare, MVT should be considered in patients with SLE and/or APS. The diagnosis of MVT requires a high index of suspicion, and early aPL testing for SLE patients is highly recommended to reduce the morbidity and mortality associated with the condition.

Schlüsselwörter

  • Anticardiolipin antibodies
  • antiphospholipid syndrome
  • mesenteric venous thrombosis
  • SLE
  • systemic lupus erythematosus
Uneingeschränkter Zugang

Intestinal Behcet’s disease with severe pulmonary arterial involvement mimicking ulcerative colitis

Online veröffentlicht: 04 Feb 2017
Seitenbereich: 715 - 718

Zusammenfassung

Abstract

Background: Behcet’s disease (BD) is a chronic inflammatory systemic vasculitic disorder and affects multiple organ systems. Although the prevalence of the disease is high in Turkey, intestinal involvement is rare.

Objective: To report a case highlighting the high risk of mortality as a result of vascular involvement in BD, and suggest classification as a differential diagnosis in intestinal disease and inflammatory bowel disease (IBD).

Method: We report a case of BD in a patient who had symptoms of IBD and was misdiagnosed as having IBD, but later diagnosed as having BD with aneurisms on pulmonary vessels.

Results: A 23-year-old woman was diagnosed with and followed for ulcerative colitis (UC) by another center for one year. She was admitted to hospital with bloody diarrhea, abdominal pain, and weight loss symptoms. There were erythema nodosum-like lesions (ENLL) at pretibial sites and pustular lesions on her upper extremities. Colonoscopy showed nonspecific ulcerations on the colon and terminal ileum and the histopathology was nonspecific. During this period she complained of hemoptysis. Computed tomography (CT) of her thorax showed vascular dilatations in the parenchyma of the lung. CT angiography showed multiple pulmonary arterial aneurisms. She reported a history of recurrent oral aphthous and genital ulcers. A pathergy test was positive and she was diagnosed as having BD with severe pulmonary arterial involvement. Prednisolone (1 mg/kg/day), and cyclophosphamide (750 mg/m2/month) was administered. At the end of the second week of treatment she showed significant clinical improvement.

Conclusion: IBD symptoms and signs may be the first presentation of BD. Because of the high risk of mortality as a result of vascular involvement, BD must be classified as a differential diagnosis in intestinal disease and IBD.

Schlüsselwörter

  • Inflammatory bowel disease
  • intestinal Behcet’s disease
  • pulmonary aneurism
Uneingeschränkter Zugang

Clinical characteristics and outcome for treatment for borderline ovarian tumor in King Chulalongkorn Memorial Hospital

Online veröffentlicht: 04 Feb 2017
Seitenbereich: 719 - 724

Zusammenfassung

Abstract

Background: Borderline ovarian tumor (BOT) is a distinct diagnosis which comprises 5%-15% of epithelial ovarian tumor. Borderline ovarian tumor is characterized histologically as an epithelial tumor with stratified growth pattern without destructive stromal invasion. From observation, BOT in our institution is more common in the mucinous cell type, as distinct from that reported in previous reviews.

Objective: This study was conducted to evaluate characteristics, treatment outcome and recurrence of BOT in our institution.

Methods: A retrospective review was made of the medical records of BOT patients to collect data. From 2006 to 2010, all 55 cases of BOT were reviewed from the aspect of general characteristics, presenting symptoms, tumor markers, pathologic diagnosis, operations, treatment outcome, and recurrence.

Results: The median age of the 55 BOT patients was 42 years. The common presenting symptoms were palpable mass, abdominal discomfort, and pelvic pain. One fourth of the patients had no symptoms. Mucinous cells were the most common subtype histologically (72.7%). Serous cell subtype were found in 21.8%. The most common surgical procedure was salpingo-oophorectomy. Median follow up time was 38 months. There was recurrence of 5 cases (9.1%) and recurrence was more common in the patients with a serous cell subtype and those who had residual tumors after primary surgery. A higher stage of disease was also associated with a greater risk of recurrence.

Conclusion: While most previous studies showed that a serous cell subtype was the most common subtype, our study found the mucinous cell subtype was the most common at our institution. Recurrence was quite common in patients with the mucinous cell subtype with microinvasion, and was more common in patients with residual tumors after primary surgery. From the aspect of recurrence, these findings were not different from those of previous studies. The optimal treatment of recurrence remains controversial.

Schlüsselwörter

  • Borderline ovarian tumor
  • microinvasive
  • mucinous
  • outcome
  • recurrence
  • serous
17 Artikel

Editorial

Uneingeschränkter Zugang

Chronic viral hepatitis: a need for a comprehensive approach

Online veröffentlicht: 04 Feb 2017
Seitenbereich: 597 - 598

Zusammenfassung

Original article

Uneingeschränkter Zugang

Natural history, outcome, and sustainability of treatment response in chronic viral hepatitis B: Thai multicenter study

Online veröffentlicht: 04 Feb 2017
Seitenbereich: 599 - 607

Zusammenfassung

Abstract

Background: Data regarding the natural history and outcome of treatment of chronic hepatitis B (CHB) patients in Thailand remain inconclusive.

Objective: We aimed to examine the natural history and outcome of therapy in Thai CHB patients treated with nucleoside analogues (NAs) monotherapy or interferon (IFN) monotherapy.

Method: CHB patients without clinical evidence of cirrhosis and alanine aminotransferase (ALT) levels >1.5 times of normal for at least 6 months were enrolled from 6 hospitals (2002 to 2005). Treatment included NAs and IFN. Treatment response was defined as ALT normalization and an HBV DNA level <10,000 copies/ml (or <2,000 IU/ml) and/or HBeAg seroconversion at the end of follow up. The study was approved by the institutional review board of each hospital.

Result: A total of 567 patients with mean age of 46.8 ± 11.9 y were included. The ratio of HBeAg positive to HBeAg negative patients was 1.3:1. Nineteen percent of patients had no HBeAg status. There were 262 HBeAg positive patients (46%) and 197 HBeAg negative patients 35%. Sixty-one percent received NAs while 20% received IFN as a first line treatment and the remaining 19% received no specific medication. For the HBeAg positive patients, HBeAg seroconversion and undetectable HBV-DNA were achieved in 32.8% and 50.5%, respectively in NAs group (on therapy), and HBeAg seroconversion and undetectable HBV-DNA were achieved in 24.3% and 21.4%, respectively in the IFN-treated group (off treatment). For the HBeAg negative patients, undetectable levels of HBV-DNA occurred in 68.8% in the NAs group while undetectable levels of HBV-DNA occurred in 37.5% of patients in the IFN-treated group. HBsAg loss was not found in the NAs group, but 2.8% of patients in IFN group had HBsAg loss. HBV DNA reappeared in the IFN group (off treatment) and NAs groups (on therapy) in 26.6% and 24.3% of patients, respectively. Minor adverse events of therapy were found in 9% of patients. Five percent of patients progressed to Child A cirrhosis and one patient in the NAs group (0.18%) died from causes unrelated to liver disease, during a 3-year follow-up.

Conclusion: The treatment response of Thai CHB patients from multicenter study showed the results similar to previous studies. However, higher durability of treatment with lower rate of reappearance of HBV DNA was observed in Thai CHB patients.

Schlüsselwörter

  • Chronic hepatitis B
  • Thai
  • multicenter study
  • natural history
  • outcome of treatment
Uneingeschränkter Zugang

Diagnostic accuracy of liver stiffness measurement and serum hyaluronic acid for detecting liver fibrosis in chronic hepatitis B with respect to ALT levels

Online veröffentlicht: 04 Feb 2017
Seitenbereich: 609 - 617

Zusammenfassung

Abstract

Background: The assessment of liver fibrosis in chronic hepatitis B is crucial in clinical practice.

Objective: We compared the diagnostic accuracy of liver stiffness measurement (LSM) using transient elastography and serum hyaluronic acid (HA) in detecting liver fibrosis (METAVIR) in chronic hepatitis B, with respect to ALT levels.

Method: One hundred fifty-six Thai patients with chronic hepatitis B who had undergone a liver biopsy were enrolled, and included 112 (71.8%) men and 44 (28.2%) women. The mean age of the patients was 40.1±12.2 years. The predictive accuracy was analyzed by comparing the areas under the receiver-operating characteristic curves (AUROCs).

Result: LSM was superior to HA in predicting fibrosis stages of ≥F2 (AUROCs were 0.820 vs 0.727, p=0.009), ≥ F3 (0.910 vs 0.848, p=0.015) and F4 (0.938 vs 0.876, p=0.031). There was significant correlation between ALT level and LSM value, while such correlation between ALT and HA was not detected. Regarding the subgroup of patients with ALT levels >80 IU/L (2 × ULN), AUROCs of LSM and HA for predicting fibrosis stages of ≥F2 (0.733 vs 0.696), ≥F3 (0.892 vs 0.844) and F4 (0.934 vs 0.893) were not significantly different.

Conclusion: LSM was superior to HA in predicting liver fibrosis and cirrhosis in patients with chronic hepatitis B. However, in patients with ALT elevation, the diagnostic performance of LSM was reduced and its accuracy was comparable to that of HA. Thus, HA could be an alternative method in assessing liver fibrosis in patients with high ALT levels.

Schlüsselwörter

  • ALT level
  • AUROC
  • cirrhosis
  • diagnostic accuracy
  • hepatitis B
  • hyaluronic acid
  • liver stiffness
  • transient elastography
Uneingeschränkter Zugang

Prevalence of hepatitis B and hepatitis C in patients referred to health centers in the Hamadan province, Iran: an epidemiologic study of infections between 2004 and 2007

Online veröffentlicht: 04 Feb 2017
Seitenbereich: 619 - 625

Zusammenfassung

Abstract

Backgroud: Hepatitis B virus (HBV) and Hepatitis C virus (HCV) are the main causes of liver related morbidity and mortality.

Objective: To assess the epidemiologic features of HBV and HCV infections between 2004 and 2007 in the Hamadan province, Iran.

Methods: In a cross-sectional study, epidemiologic and demographic characteristics of patients infected with HBV or HCV, or both, during about four years were collected from health centers in the Hamadan province.

Results: Overall, there were 1533 infected patients (66.2% with HBV, 32.5% with HCV, and 1.3% with both). Male patients comprised 74.4% of patients. In view of marital status, 71.3% were married, 27% single, and 1.7% were widowed or divorced. The majority of patients (78.4%) inhabited urban areas while 21.6% inhabited rural areas. Patients <4 years old had the lowest rate of infection (0.26%), while the highest incidence (13.11%) was found in the 25-29-year-old age range. With respect to serologic markers, 61.4%, 33.7%, 4.4% and 0.3% of patients were HBsAg+, HCVAb+, HBsAb+ and HBeAg+, respectively. Overall, the incidence of HBV was found to be decreased from 2004 to 2007, while the incidence of HCV increased from 2004 to 2007.

Conclusion: The prevalence of HBV infection decreased during the period of study. This could be attributed to the increasing public vaccination of neonates and people at high-risk, which began about 15 years ago. However, it seems that an increasing incidence of high-risk behaviors including intravenous drug abuse with shared syringes has led to an increased incidence of HCV infection.

Schlüsselwörter

  • Epidemiology
  • health center
  • hepatitis B virus
  • hepatitis C virus
  • prevalence
Uneingeschränkter Zugang

The expression and significance of FOXO3a and Jab1 in human ovarian cancer

Online veröffentlicht: 04 Feb 2017
Seitenbereich: 627 - 634

Zusammenfassung

Abstract

Background: Ovarian carcinoma represents one of the most insidious and aggressive cancers. Ovarian carcinoma is the most lethal gynecological malignancy. To discover new relevant biomarkers to increase specificity and sensitivity for early diagnosis and prognosis of ovarian cancer is important and urgently needed. FOXO3a possesses a large series function including cellular proliferation, transformation, differentiation, and longevity. Jab1 is also known as subunit 5 (CSN5) of the COP9 signalosome (CSN), a multifunctional protein complex involved in modulating signal transduction, gene transcription, and protein stability.

Objective: To investigate the importance of FOXO3a and Jab1 in ovarian cancer.

Method: Immunohistochemical analysis was performed on formalin-fixed paraffin sections of 46 specimens. Statistical analysis was conducted using the Stat View 5.0 software package.

Result: We found that Foxo3a expression correlates significantly with FIGO disease stage (p < 0.05) and lymph node involvement. Jab1 expression correlates significantly with disease stage and lymph node involvement (p < 0.05). A multivariate Cox proportional hazard model showed that Foxo3a and Jab1 were the strongest independent predictors of survival (p < 0.05), the second predictor being FIGO disease stage and lymph node involvement.

Conclusion: Understanding the precise role of Jab1 and Foxo3a in ovarian cancer progression will not only increase our knowledge of the biology of ovarian cancer but may also enable development of an novel therapeutic strategy via suppression of Jab1.

Schlüsselwörter

  • Jab1
  • FOXO3a
  • ovarian cancer
  • prognosis
  • proliferation
Uneingeschränkter Zugang

Hemiarthroplasty versus total hip arthroplasty for displaced femoral neck fractures: a meta-analysis of the literature

Online veröffentlicht: 04 Feb 2017
Seitenbereich: 635 - 647

Zusammenfassung

Abstract

Background: Hemiarthroplasty and total hip arthroplasty are the two most common methods for displaced femoral neck fracture. However, the efficacy of the two methods is still controversial and needs a comprehensive analysis.

Objective: This meta-analysis was to investigate whether total hip arthroplasty (THA) is associated with lower reoperation rate, mortality, complications, better function and quality of life than hemiarthroplasty (HA) for patients with displaced femoral neck fractures.

Materials and Methods: Thirty-one trials involving a total of 4324 patients were included. Six randomized controlled trials, 8 lower-quality randomized trials, and 17 retrospective cohort studies comparing HA with THA for displaced femoral neck fractures were assessed for eligibility. Incidence rate and risk ratios (RR) were pooled using random-effects or fixed-effects models depending on the heterogeneity of included studies.

Results: Meta-analysis showed that THA was associated with a lower risk of reoperation (incidence rate 2.8%, 95%CI 1.8%-3.8%) compared with HA (incidence rate 7.4%, 95%CI 5.3%-9.6%) (RR = 0.42, 95%CI 0.30-0.58, P < 0.001) and higher excellent and good rate by Harris hip score (RR = 1.12, 95%CI 1.06-1.19, P < 0.001). There was a tendency of better prognosis in patients undergoing THA (RRmortality = 0.82, 95%CI 0.67-1.01), but it was not statistically significant (P = 0.067). However, there was a higher risk of dislocation in patients undergoing THA (incidence rate 4.2%, 95%CI 2.7%-5.8%) compared with HA (incidence rate 2.3%, 95%CI 1.4%-3.2%) (RR = 1.79, 95%CI 1.24-2.57, P = 0.002), but there was no difference in both local infections and general complications (P = 0.201 and P = 0.712).

Conclusion: THA can benefit patients of displaced femoral neck fractures with a reduced reoperation rate and better hip function, though it can result a higher incidence of postoperative dislocation. The impact of different hip arthroplasty on prognosis need further studies.

Schlüsselwörter

  • Displaced femoral neck fractures
  • hemiarthroplasty
  • total hip arthroplasty
Uneingeschränkter Zugang

Vitamin E reduces sensory neuronal loss and improves nerve regeneration after sciatic nerve injury

Online veröffentlicht: 04 Feb 2017
Seitenbereich: 649 - 655

Zusammenfassung

Abstract

Background: Nerve injury results in axonal degeneration and loss of sensory neurons in dorsal root ganglia (DRG). Enhanced oxidative stress was also observed following injury, suggesting potential efficacy of antioxidant therapy.

Objective: To examine the effects of vitamin E on nerve regeneration after nerve injury in rats.

Method: Unilateral sciatic nerve crush was performed on rats which were divided into three groups: control and 2 doses of vitamin E. The control group received only vehicle (corn oil) and vitamin E groups received α-tocopherol 500 and 1,000 mg/kg/day once daily by gavage. Regeneration was evaluated at 10 days post-injury. In a second experiment, there were two groups, vehicle and vitamin E 500 mg/kg/day, and the regeneration duration was extended to 3 weeks.

Result: The first experiment showed that vitamin E 500 and 1,000 mg/kg/day could significantly reduce DRG neuronal loss from 31.5% in the control group to 17.1% and 13.5%. However, the regeneration distances were not significantly different among groups. In the second experiment, although vitamin E 500 mg/kg/day significantly increased the plasma vitamin E level, motor recovery of the hind limb, as assessed by walking track analysis, was not significantly improved. By contrast, nerve morphometry revealed increased density and number of myelinated fiber after vitamin E treatment.

Conclusion: Vitamin E may be beneficial to sensory neuronal loss and nerve regeneration after nerve trauma

Schlüsselwörter

  • Nerve injury
  • nerve regeneration
  • neuronal loss
  • vitamin E
  • α-tocopherol
Uneingeschränkter Zugang

Phase I study of integrating PET/CT and dose-escalated intensity modulated radiation therapy using a simultaneous integrated boost technique for thoracic esophageal cancer

Online veröffentlicht: 04 Feb 2017
Seitenbereich: 657 - 667

Zusammenfassung

Abstract

Background: Esophageal cancer has a poor prognosis because most patients have locally advanced disease upon presentation, and are therefore not suitable for upfront surgery. Modern radiation therapy techniques using intensity modulated radiation therapy (IMRT) combined with a novel imaging technique using integrated positron emission tomography and computed tomography (PET/CT) may help radiation oncologists increase radiation dose to the tumor and may improve tumor response.

Objective: The primary aim was to analyze the toxicity of dose-escalated IMRT using a simultaneous integrated boost (SIB) technique and concurrent chemotherapy in esophageal cancer patients using PET/CT as a guide for target delineation. Secondary endpoints were to evaluate response rate, overall survival, and event-free survival rates.

Method: Seventeen consecutive patients with locally advanced carcinoma of the esophagus were treated with preoperative concurrent chemoradiation that consisted of IMRT 64 Gy in 30 fractions (SIB technique), together with two cycles of cisplatin (80 mg/m2, day 1 and 29) and 5-fluorouracil (1000 mg/m2/d, days 1-4 and 29-32). Baseline PET/CT was used for staging and target delineation. After complete chemoradiation for 3 months, PET/CT was repeated and the patients were evaluated for esophagectomy. Treatment toxicities were collected. Baseline and 3-month postchemoradiation PET/CT imaging were analyzed and correlated with the pathological findings.

Result: The median follow-up time was 12 months. All 17 patients had squamous cell carcinoma of thoracic esophageal cancer and were treated with chemoradiation. The most common acute ≥grade 3 adverse effects were leucopenia (58.8) and vomiting (23.5%), respectively. Acute ≥grade 3 cardiotoxicities and pulmonary toxicities were observed in 5.9% and 11.7% of the patients, respectively. One patient (5.9%) died from an esophagopericardial fistula. Seven patients underwent esophagectomy after chemoradiation. A pathologic complete remission was achieved in 4 patients (57.1% of the surgical group or 23.5% of the entire group). The overall 1-year survival and event free survival rates for the entire group of patients were 87% and 59%, respectively. There was a statistically significant difference in the overall 1-year survival between surgical and nonsurgical groups (overall 1-year survival, 100% versus 74%, respectively, p = 0.037). In contrast, there was no significant difference in 1-year event-free survival between groups (1-year event-free survival, 72% versus 56%, p = 0.085). Applying the average absolute reduction and percentage reduction of SUVmax in these patients, PET/ CT could not predict the pathologic response.

Conclusion: Integrating PET/CT for dose-escalated IMRT in esophageal cancer patients showed acceptable toxicities and promising overall survival, especially when followed by surgery.

Schlüsselwörter

  • Chemoradiation
  • esophageal cancer
  • intensity modulated radiation therapy (IMRT)
  • positron emission tomography/computed tomography (PET/CT)
  • simultaneous integrated boost
  • target delineation
Uneingeschränkter Zugang

Effects of a daytime nap on the recognition of neutral and emotional memories

Online veröffentlicht: 04 Feb 2017
Seitenbereich: 669 - 679

Zusammenfassung

Abstract

Background: Memory can be facilitated by the emotional strength of encoded information. Offline consolidation during sleep (post-learning sleep, even as little as a nap,) also modulates declarative memory processing. Previous studies have investigated the influence of sleep, especially rapid eye movement (REM) sleep, on emotional memory facilitation in humans. However, the interaction between emotional valence asymmetry and nap-dependent memory consolidation is poorly understood.

Objective: To investigate the effects of post-learning nap on the recognition of neutral and emotional memories.

Method: Ten healthy male participants completed a study session involving 240 emotional (negative and positive stimuli with different arousal magnitudes) and neutral pictures of people, animals, objects, and landscapes. Participants were then immediately tested on the visual recognition performance, in which they need to make recognition judgments on a subset of previously seen (“old”) pictures and intermixed unseen (“new”) pictures containing similar emotional and semantic contents. Three hours after this initial baseline test, one-half of the participants obtained a 90-minute nap opportunity, recorded with electroencephalography (EEG), whereas the others remained awake. Participants were again tested on the remaining “old” and “new” pictures at 6 hours after learning session.

Results: The results revealed a beneficial effect of delayed post-learning nap on the recognition of neutral declarative memory. The extent of neutral memory facilitation was negatively correlated with the amount of stages-2 NREM. Unlike previous studies, the recognition performance for negative emotional items with high arousal condition in the Nap group deteriorated across an offline time rich in stage-2 NREM sleep. However, both groups showed similar decrease in recognition accuracy for positive stimuli.

Conclusion: Our findings suggest that declarative memories containing distinct emotional valence and arousal are consolidated differentially during wakefulness and sleep. Under certain conditions, a daytime nap rich in stage-2 NREM sleep may play an important role on these performance differences.

Schlüsselwörter

  • EEG
  • emotion
  • nap
  • NREM
  • recognition memory

Brief communication (Original)

Uneingeschränkter Zugang

The frequency of Chlamydia trachomatis and Neisseria gonorrhoeae infections among women in Kermanshah, Iran

Online veröffentlicht: 04 Feb 2017
Seitenbereich: 681 - 685

Zusammenfassung

Abstract

Background: Sexually transmitted diseases (STDs) are a major health problem in various societies. Chlamydia trachomatis and Neisseria gonorrhoeae are among the most important bacterial causes. Molecular techniques have been used for detection of these pathogens with high sensitivity and specificity.

Objective: We studied the frequency of C. trachomatis and N. gonorrhoeae in women with cervicitis in Kermanshah City.

Method: A total of 255 married women with cervicitis referred to Kermanshah’s clinics were randomly included in this study. Endocervical samples were collected using Dacron swabs and sent to the laboratory in phosphate buffered saline. The clinical symptoms of women were recorded. Samples were tested with specific primers for C. trachomatis and N. gonorrhoeae using a multiplex PCR technique.

Results: Among 255 cases, 14 (5.5%) showed bacterial infections. C. trachomatis were detected in 8 (3.1%) samples and N. gonorrhoeae were detected in 6 (2.4%) samples. The rate of infection was higher in women under the age of 25 years. There was no case of simultaneous infection for both bacteria.

Conclusion: This study indicated that the incidence of infection with C. trachomatis and N. gonorrhoeae in Kermanshah is relatively low, which is consistent with the results of other studies in Middle East.

Schlüsselwörter

  • Chlamydia trachomatis
  • infection
  • Neisseria gonorrhoeae
  • women
Uneingeschränkter Zugang

Phylogenetic analysis of VP1 region of CA16 isolated from children with severe hand-foot-mouth disease

Online veröffentlicht: 04 Feb 2017
Seitenbereich: 687 - 693

Zusammenfassung

Abstract

Background: CA16 and enterovirus 71 are two key etiological agents for children’s hand-foot-mouth disease (HFMD). Large-scale HFMD outbreaks have taken place every year in Liaocheng City, Shandong Province of China since 2008.

Objective: We investigated the genetic background and phyletic evolution of coxsackie virus A16 (CA16)-related severe HFMD in children from Liaocheng City.

Method: CA16 was screened from throat swab and anus specimens obtained from children with severe HFMD between 2008 and 2010. Specific primers were used to amplify the VP1 region of CA 16 for sequence analysis.

Result: A total of 461 specimens were detected to be enterovirus positive from 2008 to 2010 and 401 specimens were CA16 positive. The nucleotide and amino acid sequences of 16 isolates from children with severe HFMD were compared with the reference sequences, and the nucleotide homology was 91.43%-98.65%, and the amino acid homology was 97.98%-100%. Of the16 isolates, 9 isolates and BJ03-ZDP (AY821798), Shzh00-1 (AY790926), Shzh05-1 (EU262658), and GZ08 (FJ198212) strains isolated from Chinese mainland were located on the same branch; the remaining 7 isolates, the strains isolated from Malaysia, Thailand, Vietnam, Australia and other neighboring countries. AF177911 from Taiwan andshzh01-69 strain (AY895111) from Shenzhen were located on another branch.

Conclusion: CA16 is one of the major pathogens of HFMD and the homology of strains is high.

Schlüsselwörter

  • Coxsackie virus A16
  • enterovirus
  • hand-foot-mouth disease
Uneingeschränkter Zugang

Organ doses, effective dose, and radiation risk assessment in radiography of pediatric paranasal sinuses (Waters view)

Online veröffentlicht: 04 Feb 2017
Seitenbereich: 695 - 698

Zusammenfassung

Abstract

Background: For diagnosis of acute sinusitis, conventional radiography is the investigative method of choice. While radiological examinations undoubtedly help in the proper diagnosis of various diseases, their excessive use can lead to unnecessary exposure to radiation, the biggest long-term risk of which is cancer. Awareness of effective dose and radiation risk from the radiological procedure is necessary for taking decisions about executing an X- ray examination.

Objective: We evaluated organ doses, effective doses (E), and the corresponding risk of exposure-induced cancer death resulting from paranasal sinus radiography for male and female patients in all age groups.

Materials ad Method: The radiographic technique variables used for this examination of ‘standard patients’ of six different ages (newborn, 1, 5, 10, 15-year-old, and adult) were obtained from the departments of radiology of seven public hospitals in Yazd city. PCXMC software was used to simulate projections and calculate the resulting organ and effective doses from these projections. The program also calculated the risk of death for radiationinduced cancers.

Result: For the six age groups, mean effective doses (E) were found to be 20.34, 22.52, 24.52, 25.96, 31.82 and 39.81 μSv, respectively. For male and female patients, the corresponding risk ranges were 1.14-2.59 and 1.31- 3.22 per million, respectively.

Conclusion: Results of this study can be used as a guide by physicians to conduct a risk-benefit analysis to justify radiographic assessment of paranasal sinuses before it is requested; especially for children.

Schlüsselwörter

  • Paranasal sinuses
  • pediatric
  • radiation-induced cancer
  • radiography
Uneingeschränkter Zugang

Surviving acquired severe nonmalignant hemophagocytic syndrome

Online veröffentlicht: 04 Feb 2017
Seitenbereich: 699 - 704

Zusammenfassung

Abstract

Background: Hemophagocytic syndrome (HPCS) is not rare in Thailand. At present the outcome in severe cases is often unsatisfactory because of a delay in diagnosis and improper management. From 1999 to 2011, the authors have gained experience in the management of severe acquired nonmalignant HPCS in Thai adult patients. From 1999 to 2003, three out of 10 patients died. During 2005-2011, seven patients with severe HPCS survived. This improvement stimulated the authors to analyze clinical manifestations, etiology, and management of these patients.

Objective: To find the keys to successful outcomes in the management of acquired severe nonmalignant HPCS in seven survivors during 2005-2011. To alert physicians that acquired severe nonmalignant HPCS may be cured.

Materials and Methods: The records of ten patients with HPCS were analyzed. Between 1999 and 2003 three patients died. Between 2005 and 2011 seven patients survived.

Results: The three patients during 1991-2003 may well have died because of delayed diagnosis and improper management. One case of HPCS was diagnosed after death. In the other two cases etiologies were not readily identified and dealt with. In the surviving group, treatment was started as soon as HPCS was suspected or diagnosed. This consisted of removal of any known cause and aggressive management of associated conditions and complications.

Conclusion: Adults who acquire severe nonmalignant HPCS can be treated successfully. The key roles for this success are early diagnosis and appropriate management. The best supportive care and close observation by the team of hematologists and physicians also determines patient survival.

Schlüsselwörter

  • Therapy
  • acquired severe nonmalignant hemophagocytic syndrome

Clinical report

Uneingeschränkter Zugang

Delayed cerebral ischemia after clipping of middle cerebral artery aneurysms

Online veröffentlicht: 04 Feb 2017
Seitenbereich: 705 - 709

Zusammenfassung

Abstract

Background: Delayed cerebral ischemia (DCI) that occurs more than 14 days after clipping of middle cerebral artery (MCA) aneurysms is rare.

Objective:To investigate whether multiple treatments that prevent vasospasms and microthrombosis may achieve a better outcome for DCI.

Method: We present three cases of subarachnoid hemorrhage (SAH) in patients who experienced DCI before and after MCA aneurysmal clipping. Their clinical manifestations, neuroradiological aspects, treatment, and outcomes are presented. Digital subtraction angiograms and computed tomographic angiography were performed to confirm the MCA aneurysms. Aneurysmal clippings were implemented via a pterional approach within 3 days of the onset of SAH. Triple-H therapy was conducted, and nimodipine was administered intravenously. The three patients were released with intact neurological status within 14 days to 17 days of clipping.

Results: The three patients were readmitted within 7 days after discharge because of cerebral ischemia in the corresponding MCA area. Antiplatelet drugs were administered with resolution of clinical symptoms within a few days.

Conclusion: The occurrence of this kind of DCI is rare. The pathogenesis of DCI is unknown and may be complex. Multiple treatments that prevent vasospasms as well as microthrombosis may achieve a better outcome.

Schlüsselwörter

  • Aneurysm clipping
  • delayed cerebral ischemia
  • micro-thrombosis
  • middle cerebral artery
Uneingeschränkter Zugang

Mesenteric venous thrombosis in a patient with antiphospholipid syndrome and systemic lupus erythematosus

Online veröffentlicht: 04 Feb 2017
Seitenbereich: 711 - 714

Zusammenfassung

Abstract

Background: Antiphospholipid antibodies (aPL) are associated with an increased risk of venous thrombosis and can occur in patients without any associated conditions, or in those with autoimmune disorders, such as systemic lupus erythematosus (SLE). Mesenteric venous thrombosis (MVT) is one of the clinical manifestations of antiphospholipid syndrome (APS), and it has rarely been reported in patients with SLE.

Objective: To report a case of SLE complicated by APS and MVT.

Method: A 28-year-old woman with a history of SLE and lupus nephritis was admitted with nonspecific abdominal symptoms. The working diagnosis was severe SLE and paralytic ileus because of primary peritonitis.

Result: Nine days after she did not respond to symptomatic treatment, exploratory laparotomy revealed MVT and further coagulation work-up was diagnostic for APS. Despite treatment, she died because of complications of SLE and APS.

Conclusion: Though rare, MVT should be considered in patients with SLE and/or APS. The diagnosis of MVT requires a high index of suspicion, and early aPL testing for SLE patients is highly recommended to reduce the morbidity and mortality associated with the condition.

Schlüsselwörter

  • Anticardiolipin antibodies
  • antiphospholipid syndrome
  • mesenteric venous thrombosis
  • SLE
  • systemic lupus erythematosus
Uneingeschränkter Zugang

Intestinal Behcet’s disease with severe pulmonary arterial involvement mimicking ulcerative colitis

Online veröffentlicht: 04 Feb 2017
Seitenbereich: 715 - 718

Zusammenfassung

Abstract

Background: Behcet’s disease (BD) is a chronic inflammatory systemic vasculitic disorder and affects multiple organ systems. Although the prevalence of the disease is high in Turkey, intestinal involvement is rare.

Objective: To report a case highlighting the high risk of mortality as a result of vascular involvement in BD, and suggest classification as a differential diagnosis in intestinal disease and inflammatory bowel disease (IBD).

Method: We report a case of BD in a patient who had symptoms of IBD and was misdiagnosed as having IBD, but later diagnosed as having BD with aneurisms on pulmonary vessels.

Results: A 23-year-old woman was diagnosed with and followed for ulcerative colitis (UC) by another center for one year. She was admitted to hospital with bloody diarrhea, abdominal pain, and weight loss symptoms. There were erythema nodosum-like lesions (ENLL) at pretibial sites and pustular lesions on her upper extremities. Colonoscopy showed nonspecific ulcerations on the colon and terminal ileum and the histopathology was nonspecific. During this period she complained of hemoptysis. Computed tomography (CT) of her thorax showed vascular dilatations in the parenchyma of the lung. CT angiography showed multiple pulmonary arterial aneurisms. She reported a history of recurrent oral aphthous and genital ulcers. A pathergy test was positive and she was diagnosed as having BD with severe pulmonary arterial involvement. Prednisolone (1 mg/kg/day), and cyclophosphamide (750 mg/m2/month) was administered. At the end of the second week of treatment she showed significant clinical improvement.

Conclusion: IBD symptoms and signs may be the first presentation of BD. Because of the high risk of mortality as a result of vascular involvement, BD must be classified as a differential diagnosis in intestinal disease and IBD.

Schlüsselwörter

  • Inflammatory bowel disease
  • intestinal Behcet’s disease
  • pulmonary aneurism
Uneingeschränkter Zugang

Clinical characteristics and outcome for treatment for borderline ovarian tumor in King Chulalongkorn Memorial Hospital

Online veröffentlicht: 04 Feb 2017
Seitenbereich: 719 - 724

Zusammenfassung

Abstract

Background: Borderline ovarian tumor (BOT) is a distinct diagnosis which comprises 5%-15% of epithelial ovarian tumor. Borderline ovarian tumor is characterized histologically as an epithelial tumor with stratified growth pattern without destructive stromal invasion. From observation, BOT in our institution is more common in the mucinous cell type, as distinct from that reported in previous reviews.

Objective: This study was conducted to evaluate characteristics, treatment outcome and recurrence of BOT in our institution.

Methods: A retrospective review was made of the medical records of BOT patients to collect data. From 2006 to 2010, all 55 cases of BOT were reviewed from the aspect of general characteristics, presenting symptoms, tumor markers, pathologic diagnosis, operations, treatment outcome, and recurrence.

Results: The median age of the 55 BOT patients was 42 years. The common presenting symptoms were palpable mass, abdominal discomfort, and pelvic pain. One fourth of the patients had no symptoms. Mucinous cells were the most common subtype histologically (72.7%). Serous cell subtype were found in 21.8%. The most common surgical procedure was salpingo-oophorectomy. Median follow up time was 38 months. There was recurrence of 5 cases (9.1%) and recurrence was more common in the patients with a serous cell subtype and those who had residual tumors after primary surgery. A higher stage of disease was also associated with a greater risk of recurrence.

Conclusion: While most previous studies showed that a serous cell subtype was the most common subtype, our study found the mucinous cell subtype was the most common at our institution. Recurrence was quite common in patients with the mucinous cell subtype with microinvasion, and was more common in patients with residual tumors after primary surgery. From the aspect of recurrence, these findings were not different from those of previous studies. The optimal treatment of recurrence remains controversial.

Schlüsselwörter

  • Borderline ovarian tumor
  • microinvasive
  • mucinous
  • outcome
  • recurrence
  • serous

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