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Deteriorating patients

Fabrizio Luca, Danielle K Craigg, Maheswari Senthil, Matthew J Selleck, Blake D Babcock, Mark E Reeves, Carlos A Garberoglio
Several studies have reported high rates of urogenital dysfunction after open and laparoscopic surgery for rectal cancer. Robotic surgery has several features that could facilitate identification and preservation of autonomic nerves. This manuscript aims to summarize the literature regarding urogenital function after robotic rectal cancer surgery and focus on technical aspects of nerve-sparing total mesorectal excision. Comprehensive searches were conducted through online databases. Selection criteria included: original articles assessing urinary and sexual function after robotic surgery of males and/or females with standardized questionnaires...
August 17, 2018: Updates in Surgery
Sidra Zafar, M A Rehman Siddiqui
BACKGROUND: Sub-retinal abscess as the presenting feature in the setting of endogenous fungal endophthalmitis is extremely infrequent. Immunodeficiency states are major predisposing risk factors. To the best of our knowledge, this is the first case report of Candida sub-retinal abscess as initial presentation in an immunocompetent patient. CASE PRESENTATION: A 32-year old, generally fit and well, female presented to us with gradually deteriorating vision in her right eye...
August 17, 2018: BMC Research Notes
Öznur Büyükturan, Buket Büyükturan, Aysu Yetiş, Mehmet İlkin Naharcı, Nuray Kırdı
Background/aim: This study aimed to assess validity and reliability of the Turkish version of Pain Assessment Checklist for Seniors with Limited Ability to Communicate (PACSLAC-T). Materials and methods: The individuals who met inclusion criteria of the study were in patients of a hospital and a long-term care facility. Mini Mental Status Exam (MMSE), Cornell Dementia Depression Scale (CDDS), Global Deterioration Scale (GDS), visual analogue scale (VAS), and PACSLAC-T were administered to all subjects...
August 16, 2018: Turkish Journal of Medical Sciences
Ji Woong Roh, Young-Guk Ko, Chul-Min Ahn, Sung-Jin Hong, Dong-Ho Shin, Jung-Sun Kim, Byeong-Keuk Kim, Donghoon Choi, Myeong-Ki Hong, Yangsoo Jang
BACKGROUND: Currently, there exists limited data on patient outcome following the use of drug-coated balloons to treat complex femoropopliteal arterial occlusive lesions. The aim of the present study was to investigate the outcomes of patient treated with drug-coated balloons (DCB) and to identify predictors of restenosis. METHODS: We retrospectively investigated medical records from 120 patients (137 limbs) treated with DCBs for femoropopliteal lesions at a single center between 2013 and 2016...
August 14, 2018: Annals of Vascular Surgery
Alexander Tuchman, Lawrence G Lenke, Meghan Cerpa, Michael G Fehlings, Stephen J Lewis, Christopher I Shaffrey, Kenneth M C Cheung, Leah Yacat Carreon, Mark B Dekutoski, Frank J Schwab, Oheneba Boachie-Adjei, Khaled Kebaish, Christopher P Ames, Yong Qiu, Yukihiro Matsuyama, Benny T Dahl, Hossein Mehdian, Ferran Pellisé, Sigurd H Berven
BACKGROUND CONTEXT: Scoli-RISK-1 is a multicenter prospective cohort designed to study neurologic outcomes following complex adult spinal deformity (ASD). The effect of unilateral versus bilateral postoperative motor deficits on the likelihood of long term recovery has not been previously studied in this population. PURPOSE: Evaluate if bilateral postoperative neurologic deficits have a worse recovery than unilateral deficits. STUDY DESIGN: Secondary analysis of a prospective, multicenter, international cohort study...
August 14, 2018: Spine Journal: Official Journal of the North American Spine Society
Brigitte Katharina Ziegelmüller, Bernadett Szabados, Annabel Spek, Jozefina Casuscelli, Christian Stief, Michael Staehler
INTRODUCTION: Emphysematous pyelonephritis is a rare necrotizing infection of the kidney with a poor prognosis. If it occurs in patients with a reduced general condition, this infection is life threatening. Early diagnosis is made by computed tomography. Treatment options are drainage and intensive care or immediate nephrectomy in severe cases. CASE DESCRIPTION: A 73-year-old woman in a poor general condition presented with a fulminant urosepsis. Computed tomography revealed an impressive abscess formation of the right kidney with free air retro and intraperitoneal...
August 2018: Urologia
Hiroshi Tsubamoto, Tomoko Ueda, Kayo Inoue, Roze Isono-Nakata, Shinichiro Saeki, Yu Kato, Hiroaki Shibahara
AIM: To investigate the effects of leuprorelin using a self-administered quality-of-life (QOL) questionnaire in patients with recurrent gynecological cancer. METHODS: Records of patients who received 3.75 mg leuprorelin every 4 weeks for the treatment of recurrent gynecological cancer were retrospectively reviewed. The physical domain of the QOL questionnaire, Care Notebook, was used to assess physical symptoms. Symptom deterioration was defined as a ≥10-point increase in baseline score; otherwise, symptoms were defined as controlled...
August 16, 2018: Journal of Obstetrics and Gynaecology Research
Tereza Vitvarová, David Neumann, Radka Šimáková, Jan Kremláček
Objective: The poor metabolic control in type 1 diabetes mellitus (T1D) has a negative impact on the developing brain. Hyperglycemia and glycemic fluctuations disrupt mainly executive functions. To assess a hypothesized deficit of the executive functions, we evaluated visual processing and reaction time in an oddball task. Methods: Oddball visual event-related potentials (ERPs), reaction time, and pattern-reversal visual evoked potentials (VEPs) were examined in a cohort of twenty-two 12- to 18-year-old T1D patients without diabetic retinopathy at normal glycemia and in nineteen 10- to 21-year-old healthy controls...
2018: Journal of Diabetes Research
Elliott C Fox, Venkata Manchala
BACKGROUND Retropharyngeal hematoma is a relatively rare diagnosis that requires a high clinical suspicion and stabilization of the airway to prevent rapid deterioration. We report a case of a spontaneous retropharyngeal hematoma in an elderly patient with myelodysplastic syndrome and associated thrombocytopenia. CASE REPORT A 90-year-old man with myelodysplastic syndrome was brought to the Emergency Department with complaints of difficulty swallowing and muffled voice for 24 hours. Upon arrival, his vital signs and physical exam were unremarkable, except that when he was asked to take a sip of water, he could not swallow it...
August 17, 2018: American Journal of Case Reports
Beom-Jun Kim, Seung Hun Lee, Mi Kyung Kwak, Carlos M Isales, Jung-Min Koh, Mark W Hamrick
Despite the potential detrimental effects of systemic inflammation on muscle mass, which is mainly observed in patients with pathologic diseases, its role in muscle strength, especially in a healthy general population reflecting subclinical low-grade inflammation, is unclear. This is a nationally representative population-based, cross-sectional study from the Korea National Health and Nutrition Examination Survey, which enrolled 1,036 men aged ≥50 years and 1,080 postmenopausal women. After adjustment for confounders, serum high-sensitivity C-reactive protein (hsCRP) level was inversely associated with hand grip strength (HGS) in men...
August 16, 2018: Aging
Tiago Lobo Ferreira, Tiago Nunes da Silva, Dolores Canário, Maria Francisca Delerue
Ectopic adrenocorticotropic hormone (ACTH) secretion represents 5%-10% of cases of Cushing's syndrome (CS), and approximately 50%-60% of these arise from neuroendocrine lung tumours, including small-cell lung cancer (SCLC). We report a 42-year-old man admitted with hypertension, metabolic alkalosis and severe hypokalaemia. On physical examination, centripetal obesity with 'moon face' and 'buffalo's hump' were identified, and wheezing on left lung was heard. A markedly elevated serum cortisol, ACTH and urine free cortisol production supported the diagnosis of CS...
August 16, 2018: BMJ Case Reports
Lindsay H Dewa, Elizabeth Cecil, Lynne Eastwood, Ara Darzi, Paul Aylin
BACKGROUND: The first signs of serious mental illnesses (SMIs) including schizophrenia, bipolar disorder and major depression are likely to occur before the age of 25. The combination of high prevalence of severe mental health symptoms, inability to recognise mental health deterioration and increased likelihood of comorbidity in a complex transitional young group makes detecting deterioration paramount. Whilst studies have examined physical and mental health deterioration in adults, no systematic review has examined the indicators of mental and physical deterioration in young adults with SMI...
August 16, 2018: Systematic Reviews
Gemma Clarke, Elizabeth Fistein, Anthony Holland, Jake Tobin, Sam Barclay, Stephen Barclay
BACKGROUND: Dysphagia and other eating and drinking difficulties are common in progressive neurological diseases. Mealtimes can become a major source of difficulty and anxiety for patients and their families. Decisions about eating, drinking and care can become challenging as disease progresses, and the person in question loses the capacity to participate in decisions about their own care. We sought to investigate how patients and their family members make decisions about their future care as their condition deteriorates, with a particular focus on mealtimes, eating and drinking...
August 16, 2018: BMC Neurology
Raji Lenin, Peter G Nagy, Jordy Gentry, Rajashekhar Gangaraju
Stress-associated premature senescence plays a major role in retinal diseases. In this study, we investigated the relationship between endothelial dysfunction, endoplasmic reticulum (ER) stress, and cellular senescence in the development of retinal dysfunction. We tested the hypothesis that constant endothelial activation by transmembrane tumor necrosis factor-α (tmTNF-α) exacerbates age-induced visual deficits via senescence-mediated ER stress in this model. To address this, we employed a mouse model of chronic vascular activation using endothelial-specific TNF-α-expressing (tie2-TNF) mice at 5 and 10 months of age...
August 16, 2018: Experimental Biology and Medicine
Alberto Repossini, Lorenzo Di Bacco, Laszlo Gazdag, Herko Grubitzsch, Theodor Fischlein, Alessandra Stara, Claudio Muneretto, Giuseppe Santarpino
BACKGROUND:  The Freedom SOLO (FS) stentless bovine-pericardial prosthesis with a supra-annular implantation technique can be a viable option for patients with endocarditic annular destruction. We assessed early- and long-term outcomes following the use of this prosthesis in extensive aortic valve endocarditis. METHODS:  From 2006 to 2016, 59 patients with extensive aortic endocarditis underwent aortic valve replacement (AVR) with FS (cumulative follow-up 263 patients-years) in three European centers; all patients presented annular tissue infection, while 54...
August 16, 2018: Thoracic and Cardiovascular Surgeon
Osamu Kitahara, Kei Nishiyama, Bunsei Yamamoto, Shigeaki Inoue, Sadaki Inokuchi
This study aimed to determine the accuracy of the quick Sequential Organ Failure Assessment (qSOFA) score in predicting mortality among prehospital patients with and without infection. This single-center, retrospective, cross-sectional study was conducted among patients who arrived via the emergency medical services (EMS). We calculated the qSOFA score and Modified Early Warning Score (MEWS) from prehospital records. We identified patients as infected if they received intravenous antibiotics at the emergency department or within the first 24 hours...
2018: PloS One
Annica Almståhl, Jessica Skoogh Andersson, Torgny Alstad, Bodil Fagerberg-Mohlin, Caterina Finizia
OBJECTIVE: The aim of this study was to analyse quality of life (QoL) pretreatment and up to 24 months post radiation therapy (RT) in patients with head and neck (H&N) cancer. METHODS: 29 patients (19 men and 10 women) with a mean age of 59±8 years were included. The stimulated salivary secretion was measured and the patients completed the European Organisation for Research and Treatment of Cancer Quality of Life questionnaires (EORTC QLQ-C30 and H&N35) and the Hospital Anxiety and Depression scale (HADS) pretreatment and at 6, 12 and 24 months post RT...
August 16, 2018: International Journal of Dental Hygiene
Daniel Neu, Nina Baniasadi, Johan Newell, David Styczen, Régine Glineur, Olivier Mairesse
Sleep-related bruxism may directly impact sleep quality. This study aims to evaluate potential relationships between sleep bruxism events and related daytime symptoms. We investigated 22 patients (42.1 ± 11.6 yr of age) with sleep bruxism in comparison with 12 good sleeper control subjects of similar age (41.0 ± 11.5 yr). Sleep bruxism was visually analyzed and categorized according to sleep stage, bruxism type (tonic/phasic) and duration. Clinical instruments comprised the Epworth Sleepiness, the Brugmann Fatigue Scale, and the Hospital Anxiety and Depression Rating Scale...
August 16, 2018: European Journal of Oral Sciences
Yao Kou, Mohammad Shboul, Zhihao Wang, Qasem Shersheer, Zhaojie Lyu, Peirong Liu, Xiaodong Zhao, Jing Tian
INTRODUCTION: Cockayne syndrome (CS) is a rare multisystemic autosomal recessive disease. The primary manifestations of which are developmental delay, neurological impairment, abnormal skin sensitivity to sunlight and unique facial appearance as sunken eyes, large ears, and thin large nose. The disorders of the nucleotide excision repair system significantly are caused by mutations of Excision repair cross-complementing group 6 (ERCC6) and Excision repair cross-complementing group 8 (ERCC8) genes, and the ERCC6 gene mutations are present in approximately 65% of cases...
August 2018: Medicine (Baltimore)
Hiroki Sato, Terasu Honma, Takashi Owaki, Kentaro Tominaga, Junji Yokoyama, Shuji Terai
BACKGROUND: Eosinophilic gastroenteritis (EoGE) can be diagnosed on the basis of histologic criteria; however, the pathology is considered to be heterogeneous. There is no consensus on the management of this enigmatic disorder with an unknown etiology. PATIENTS AND METHODS: Data for patients diagnosed with EoGE and followed up over a 1-year period were analyzed. Their symptoms, patterns of flares, and type of treatment were documented. The shift in peripheral blood eosinophil levels was also examined...
August 14, 2018: European Journal of Gastroenterology & Hepatology
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