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101.
An eleven-year-old clinically dysmorphic and devel-opmentally retarded male child presenting with com-plaints of 5 episodes of recurrent cholestatic jaundice since 3 years of age was evaluated. Imaging revealed features consistent with congenital extrahepatic porto-caval shunt(Abernethy type 1b), multiple regenerative liver nodules and intrahepatic biliary radical dilatation. The presence of ductal paucity and trisomy 8 were con-firmed on liver biopsy and karyotyping. The explanation for unusual and previously unreported features in the present case has been proposed. 相似文献
102.
D'Haens GR Panaccione R Higgins PD Vermeire S Gassull M Chowers Y Hanauer SB Herfarth H Hommes DW Kamm M Löfberg R Quary A Sands B Sood A Watermeyer G Watermayer G Lashner B Lémann M Plevy S Reinisch W Schreiber S Siegel C Targan S Watanabe M Feagan B Sandborn WJ Colombel JF Travis S 《The American journal of gastroenterology》2011,106(2):199-212; quiz 213
The advent of biological therapy has revolutionized inflammatory bowel disease (IBD) care. Nonetheless, not all patients require biological therapy. Selection of patients depends on clinical characteristics, previous response to other medical therapy, and comorbid conditions. Availability, reimbursement guidelines, and patient preferences guide the choice of first-line biological therapy for luminal Crohn's disease (CD). Infliximab (IFX) has the most extensive clinical trial data, but other biological agents (adalimumab (ADA), certolizumab pegol (CZP), and natalizumab (NAT)) appear to have similar benefits in CD. Steroid-refractory, steroid-dependent, or complex fistulizing CD are indications for starting biological therapy, after surgical drainage of any sepsis. For fistulizing CD, the efficacy of IFX for inducing fistula closure is best documented. Unique risks of NAT account for its labeling as a second-line biological agent in some countries. Patients who respond to induction therapy benefit from systematic re-treatment. The combination of IFX with azathioprine is better than monotherapy for induction of remission and mucosal healing up to 1 year in patients who are na?ve to both agents. Whether this applies to other agents remains unknown. IFX is also effective for treatment-refractory, moderate, or severely active ulcerative colitis. Patients who have a diminished or loss of response to anti-tumor necrosis factor (TNF) therapy may respond to dose adjustment of the same agent or switching to another agent. Careful consideration should be given to the reasons for loss of response. There are insufficient data to make recommendations on when to stop anti-TNF therapy. Preliminary evidence suggests that a substantial proportion of patients in clinical remission for >1 year, without signs of active inflammation can remain in remission after stopping treatment. 相似文献
103.
Bishav Mohan Shibba Takkar Chhabra Naved Aslam Gurpreet Singh Wander Naresh Kumar Sood Sumati Verma Anil Kumar Mehra Sarit Sharma 《World journal of cardiology》2013,5(5):141-147
AIM: To assess role of combined modality of mechanical fragmentation and intralesional thrombolysis in patients with massive pulmonary embolism presenting subacutely. METHODS: Eight of 70 patients presenting in tertiary care centre of North India with massive pulmonary embolism within 4 years had subacute presentation (symptom onset more than 2 wk). These patients were subjected to pulmonary angiography with intention to treat basis via mechanical breakdown and intra lesional thrombolysis. Mechanical breakdown of embolus was accomplished with 5-F multipurpose catheter to reestablish flow, followed by intralesional infusion of urokinase (4400 IU/kg over 10 min followed by 4400 IU/kg per hour over 24 h). RESULTS: Eight patients, mean age 47.77±12.20 years presented with subacute pulmonary embolism (mean duration of symptoms 2.4 wk). At presentation, mean heart rate, shock index, miller score and mean pulmonary pressures were 101.5±15.2/min, 0.995±0.156, 23.87±3.76 and 37.62±6.67 mmHg which reduced to 91.5±12.2/min (P=0.0325), 0.789±0.139 (P=0.0019), 5.87±1.73 (P=0.0000004) and 27.75±8.66 mmHg (P=0.0003) post procedurally. Mean BP improved from 80.00±3.09 mmHg to 90.58±9.13 mmHg (P=0.0100) post procedurally. Minor complications in the form of local hematoma-minor hematoma in 1 (12.5%), and pseudoaneurysm (due to femoral artery puncture) in 1 (12.5 %) patient were seen. At 30 d and 6 mo follow up survival rate was 100% and all the patients were asymptomatic and in New York Heart Association class 1. CONCLUSION: Combined modality of mechanical fragmentation and intralesional thrombolysis appears to be a promising alternative to high risk surgical procedures in patients with subacute massive pulmonary embolism. 相似文献
104.
105.
106.
Systemic inflammatory response syndrome in acute‐on‐chronic liver failure: Relevance of ‘golden window’: A prospective study
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Ashok Choudhury Manoj Kumar Barjesh C Sharma Rakhi Maiwall Viniyendra Pamecha Richard Moreau Yogesh K Chawla Ajay Duseja Mamun Mahtab Salimur Rahman Saeed S Hamid Amna S Butt Wasim Jafri Seok Siam Tan Harshad Devarbhavi Deepak Amarapurkar Qin Ning C E Eapen Ashish Goel Dong J Kim Hasmik Ghazinyan Gamal Shiha Guan H Lee Zaigham Abbas Diana A Payawal A Kadir Dokmeci Man‐Fung Yuen Laurentius A Lesmana Ajit Sood Albert Chan George K Lau Ji Dong Jia Zhongping Duan Chen Yu Osamu Yokosuka Priyanka Jain Ajeet S Bhadoria Guresh Kumar Shiv K Sarin for the APASL ACLF working party 《Journal of gastroenterology and hepatology》2017,32(12):1989-1997
107.
A novel finding of oligodontia and ankyloglossia in a 14‐year‐old with Floating‐Harbor syndrome
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Akshara Singh MDS Hind Pal Bhatia MDS Shveta Sood MDS Naresh Sharma MDS Amit Mohan MDS 《Special care in dentistry》2017,37(6):318-321
Floating‐Harbor syndrome (FHS) is a rare genetic condition characterized by distinct facial features, short stature and delayed skeletal development. Here we present case of a 14‐year‐old boy with short stature, typical facial features, impaired voice quality, clinodactyly, cryptorchidism and unilateral agenesis of kidney. In addition he had oligodontia and ankyloglossia with features suggestive of FHS. Treatment rendered was restoration of caries, application of pit and fissure sealants followed by frenectomy. The purpose of this report is to highlight the oral developmental anomalies and the management of a patient with FHS and to add to the current knowledge of the literature on this syndrome. 相似文献
108.
Dengue fever is a very common arthropod – borne infection in tropical countries. Neurological complications in dengue fever are relatively uncommon and among these, isolated cranial neuropathies have been reported only very rarely. We present an unusual neurological complication of Bell's palsy (lower motor neuron 7 th nerve palsy) associated with dengue infection. To the best of our knowledge, there have been very few documented cases of Flavivirus causing isolated Bell's palsy. 相似文献
109.
Bishav Mohan Gaurav Mohan Rohit Tandon Shalinder Kumbkarni Shibba Takkar Chhabra Naved Aslam Naresh Kumar Sood Gurpreet Singh Wander 《Indian heart journal》2014,66(1):83-86
Post-catheterization PSA is one of the most commonly encountered vascular complications of cardiac and peripheral angiographic procedures. We report the case of patient who developed deep-seated profunda femoris artery pseudoaneurysm (PSA) following cardiac catheterization. Despite, repeated ultrasound guided compressions the PSA failed to close and instead produced local site pressure ulcers. The secondary infection followed which precluded use of percutaneous thrombin injection. The PSA was finally closed via a total endovascular technique combining intravascular thrombin injection and coil embolization, thus obviating the need for expensive measures like cover stents or invasive surgical repairs. 相似文献
110.
We are sometimes faced with psychic derangement or overlay in some of the ENT diseases and the link between patient’s psyche
and any ENT disease at times becomes signifi cant and troublesome. The conditions in the fi eld between otorhinolaryngology
and psychiatry can be classifi ed as psychiatric symptoms resulting from ENT diseases or interventions and those expressing
themselves as ENT symptoms due to mental ailment. The former include hearing impairment, dizziness, tinnitus, choked airway,
bad oral breath, stuffy nose, traumatic interventions and external nasal deformities. The later include exaggerated and diminished
pharyngeal refl ex, globus hystericus, speech disorders, vasomotor rhinitis, nose picking, choked feeling, dizziness and headache.
At times diseases originate in the human mind (consciousness), causing negative thoughts like jealousy, anger, and depression
due to frustration. p ]A healthy mind in a healthy body generates sound and noble thoughts. Once a healthy body-mind relationship
is established, we can be reasonably sure that greater happiness and success is within our reach. Patient seeking help from
ENT surgeons to change their physical appearances and or function may not understand that the ultimate goal of surgery is
to bring about psychological change by modifying the physical change, which is important aspect in septorhinoplastic surgery.
At times patients asking for corrective rhinoplasty for minor external nasal deformities may have underlying psychological
disturbance and use even slight external nasal deformity as scapegoat for psychological upset. Males are more diffi cult patients
psychologically for any facial cosmetic surgery. These days some patients read about their diseases or treatment on the Internet
and get more confused and psychologically disturbed due to rare causes of their illness, rare complications and diversity
of treatment available. 相似文献