Endemic Norovirus Infections in Children,Ho Chi Minh City,Vietnam, 2009–2010

We performed a case–control investigation to identify risk factors for norovirus infections among children in Vietnam. Of samples from 1,419 children who had diarrhea and 609 who were asymptomatic, 20.6% and 2.8%, respectively, were norovirus positive. Risk factors included residential crowding and symptomatic contacts, indicating person-to-person transmission of norovirus.     

Comparative study of clinical, pathological and biological characteristics of symptomatic versus asymptomatic breast cancers

Background:It is well known that mammographic screening reducesbreast cancer mortality. One possible explanation for this effect is thatscreening makes it possible to detect smaller breast cancers with fewerinvolved nodes, but another hypothesis is that some screening-detected tumorsare in a pathologically and biologically different phase of evolution fromthose that are detected clinically. The aim of the present study was tocompare the biological, pathological and clinical characteristics ofsymptomatic vs. asymptomatic breast cancers. Patients and methods:The study considers a series of 1916consecutive patients who underwent surgery for stage I and II infiltratingbreast cancer at Verona hospitals after having undergone ultrasound andmammography (at least one of which was positive). They were divided into twogroups on the basis of why they decided to undergo the imaging examinations:group A refers to the 1247 patients with a palpable lump, and group B to the616 who were asymptomatic. Results:The patients in group A were older, and had larger tumorsand a higher percentage of positive nodes than those in group B; they also hadsignificantly higher grade tumors, higher Ki-67 levels, and a higherpercentage of ER and PgR negative and c-erbB-2 positive tumors (allof the P-values were significant). A logistic regression analysisadjusted for tumor diameter and age showed a reduction in the significance ofeach of the considered variables, but all of them remained significantlyassociated with the modality of diagnosis except ER, PgR andc-erbB-2. Conclusions:Our results suggest that asymptomatic tumors arebiologically different from their clinically presenting counterparts, thusconfirming the hypothesis that progression towards greater malignancy mayoccur during the natural history of breast cancer.     

Management of symptomatic hyponatraemia: dependence on the duration of development

Abstract. Serious neurological symptoms are common in patients with a serum sodium concentration below 115 mmol l^-1. The treatment is controversial and the most adequate rate of sodium correction to avoid both morbidity due to residual hypo-osmolality and therapy-induced neurological sequelae is debated. The management of symptomatic hyponatraemia is discussed here against the background of two cases and a literature review. It is concluded that the treatment should be based on whether the electrolyte disturbance is acute (< 24–36 h) or has developed insidiously. Slow sodium correction (< 0.5 mmol l^-1 h^-1) in patients with chronic hyponatraemia and rapid correction (1–2 mmol l^-1 h^-1) to a moderately hyponatraemic level in those with an acute development are recommended. If available data do not permit differentiation between the two conditions in a patient with seizures or in coma, rapid correction with sodium chloride and furosemide for 3–4 h followed by slow correction therapy is suggested.     

Laparoscopic cholecystectomy for asymptomatic cholelithiasis

Background: Laparoscopic clolecystectomy is now the most appropriate treatment for most patients with symptomatic cholelithiasis (S‐Chole). However, the management of patients with asymptomatic cholelithiasis (A‐Chole) remains controversial. Our research is aimed at determining whether laparoscopic cholecystectomy for patients with A‐Chole is safer, more effective and more convenient than laparoscopic cholecystectomy for patients with S‐Chole. Methods: We retrospectively conducted a review of 254 patients with A‐Chole who underwent laparoscopic cholecystectomy in an effort to compare the intraoperative course, postoperative recovery and morbidity and mortality with 432 patients with S‐Chole who underwent laparoscopic cholecystectomy. Results: The mean operative time in the A‐Chole group was significantly shorter than that in the S‐Chole group at 92.1 min versus 106.0 min, respectively. The mean intraoperative blood loss was not significantly different between the two groups. There were no significant differences between the two groups, regarding the postoperative recovery. Conversion rate to open laparotomy in the A‐Chole group was significantly lower than that in the S‐Chole group, at 1.57% versus 4.6%, respectively. The morbidity rates were 4.72% in the A‐Chole group and 8.80% in the S‐Chole group, the morbidity rate in the A‐Chole group being significantly lower than that in the S‐Chole group. There was no death in the A‐Chole group. Gallbladder cancer was incidentally diagnosed in two patients with A‐Chole after laparoscopic cholecystectomy. They underwent an additional operation and were alive with no recurrence. Conclusion: Laparoscopic cholecystectomy for patients with A‐Chole is a safe procedure with a low rate of morbidity and mortality.     

Hemicrania Continua‐Like Headache Related to Transdermal Nitroglycerine Therapy

Several cases of symptomatic hemicrania continua (HC) have been reported. A 66‐year‐old man, suffering from migraine without aura, presented with a four month history of a new headache fulfilling the ICHD 3beta clinical criteria for HC. HC onset was strictly related to the use of transdermal nitroglycerine patch (TNP). In agreement with the cardiologist, TNP was discontinued and the headache promptly disappeared; symptoms reappeared within 6‐12 hours after nitroglycerine reintroduction. After permanent discontinuation of TNP, headache disappeared at one year follow‐up. To the best of our knowledge, this is the first report of the occurrence of an HC‐like headache related to TNP.     

External validation of the SEDAN score: The real world practice of a single center

Background and Purpose:

Symptomatic intracranial hemorrhage (sICH) is the most serious adverse event in stroke patients who received i.v. rt-PA and is usually associated with poor outcomes. The SEDAN score is built up to predict sICH. We aim to externally validate the SEDAN score in Thai patients from single center in the real world practice.

Materials and Methods:

The SEDAN score of stroke patients treated with intravenous rt-PA at Thammasat University Hospital from January 2010 to June 2012 was calculated. Patients were divided into three groups including symptomatic intracranial hemorrhage (sICH), asymptomatic intracranial hemorrhage (AsICH) and no intracerebral hemorrhage (NoICH). The primary outcome of analyses was sICH. Each parameter of the SEDAN score and correlation between score and sICH were analyzed with univariate and multivariate model.

Results:

295 patients (18.6% of stroke admission) were treated with i.v. rt-PA. 13 patients (4.4%) had sICH and 31 patients (10.4%) had AsICH. Baseline blood sugar >12 mmol/l, early infarction, hyperdense cerebral artery, age >75 years-old and NIHSS ≥10(SEDAN) were associated with sICH by univariate analysis (P value = 0.018, <0.001, <0.001, 0.002 and 0.027 respectively). The rate of sICH occurrence was increased in accordance with the increasing of the SEDAN score. By multivariate analysis, odds ratio of baseline blood sugar >12 mmol/l, early infarction, hyperdense cerebral artery, age >75 years-old and NIHSS ≥10 were 1.248, 2.503, 1.107, 1.532 and 1.263 respectively.

Conclusions:

The SEDAN score was practical to use and predictive in Thai population. Each parameter of the SEDAN score was an independent risk factor for sICH after treatment with i.v. rt-PA.     

Success Rate of 3 Injection Methods with Articaine for Mandibular First Molars with Symptomatic Irreversible Pulpitis: A CONSORT Randomized Double-blind Clinical Trial

Introduction

Previous studies have reported that it is difficult to obtain proper anesthesia in mandibular molars with symptomatic irreversible pulpitis, and supplemental injections are usually unavoidable. The aim of the present study was to determine the anesthetic efficacy of articaine in mandibular first molars with symptomatic irreversible pulpitis with 3 injection methods: an inferior alveolar nerve block (IANB), an IANB with an intraligamentary injection, and an IANB with buccal infiltration before initiating the endodontic treatment.

Intracanal Cryotherapy Reduces Postoperative Pain in Teeth with Symptomatic Apical Periodontitis: A Randomized Multicenter Clinical Trial

Introduction

A prospective, multicentered, randomized clinical trial was designed to assess if controlled irrigation with cold saline could result in less incidence and intensity of postoperative pain in patients presenting with pulp necrosis and symptomatic apical periodontitis.