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1.
a. lobrano k. blanchard t.l. abell a. minocha w. boone j. wyatt-ashmead † j. fratkin † c. subramony † a. wee jr ‡ g. di nardo § g. barbara § v. stanghellini § & r. de giorgio § 《Neurogastroenterology and motility》2006,18(2):162-167
BACKGROUND AND AIM: Severe dysautonomia may be secondary to viral infections, resulting in impaired autoimmune, cardiovascular, urinary and digestive dysfunction. Herein, we present a case of a 31-year-old white female patient who had severe gastroparesis related to autonomic failure following an episode of acute gastroenteritis. This seems to be the first report providing thorough assessment of the enteric and autonomic nervous system by analysis of full-thickness small intestinal biopsies, cardiovagal testing and autopsy. HOSPITAL COURSE: This patient affected by a severe gastroparesis was treated with antiemetics, prokinetics, analgesics and gastric electrical stimulation to control symptoms. Nutritional support was made using jejunal feeding tube and, in the final stage of disease, with total parenteral nutrition. Autonomic studies revealed minimal heart rate variability and a disordered Valsalva manoeuvre although the enteric nervous system and the smooth muscle layer showed a normal appearance. Hospital courses were complicated by episodes of bacteraemia and fungemia. Serum antiphospholipid antibodies were noted but despite anticoagulation, she developed a pulmonary embolism and shortly thereafter the patient died. Autopsy revealed acute haemorrhagic Candida pneumonia with left main pulmonary artery thrombus. Sympathetic chain analysis revealed decreased myelinated axons with vacuolar degeneration and patchy inflammation consistent with Guillain-Barre syndrome. The evaluation of the enteric nervous system in the stomach and small bowel revealed no evidence of enteric neuropathy or myopathy. CONCLUSION: A Guillain-Barre-like disease with gastroparesis following acute gastroenteritis is supported by physiological and autonomic studies with histological findings. 相似文献
2.
Chronic intestinal pseudo-obstruction: manifestations, natural history and management 总被引:2,自引:0,他引:2
v. stanghellini r. f. cogliandro r. de giorgio g. barbara b. salvioli & r. corinaldesi 《Neurogastroenterology and motility》2007,19(6):440-452
Chronic intestinal pseudo-obstruction (CIPO) is a rare pathological condition characterized by a marked derangement of gut propulsive motility mimicking mechanical obstruction, in the absence of any lesion occluding the gut lumen. This disease is often associated with a disabling and potentially life-threatening complications and is still too often unrecognized even in referral centres. As a result, patients receive neither appropriate care nor recognition of their severe health condition. Medical and surgical therapies are often unsatisfactory and long-term outcome turns out to be poor in the vast majority of cases. This article focuses on the main clinical features, the management and long-term outcome of patients affected by CIPO, with particular emphasis on those aspects which remain a matter of debate. 相似文献
3.
Background
Children and adolescents dying from complex chronic conditions require paediatric palliative care. One aim of palliative care is to enable a home death if desired and well supported. However, there is little data to inform care, particularly from countries without paediatric palliative care, which constitute the majority worldwide.Methods
This is an epidemiological study analysing death certificate data of decedents aged between 0 and 17 years in Portugal, a developed Western European country without recognised provision of paediatric palliative care, from 1987 to 2011. We analysed death certificate data on cause and place of death; the main outcome measure was home death. Complex chronic conditions included cancer, cardiovascular, neuromuscular, congenital/genetic, respiratory, metabolic, gastro-intestinal, renal, and haematology/immunodeficiency conditions. Multivariate analysis determined factors associated with home death in these conditions.Results
Annual deaths decreased from 3268 to 572. Of 38,870 deaths, 10,571 were caused by complex chronic conditions, their overall proportion increasing from 23.7% to 33.4% (22.4% to 45.4% above age 1-year). For these children, median age of death increased from 0.5 to 4.32-years; 19.4% of deaths occurred at home, declining from 35.6% to 11.5%; factors associated with home death were year of death (adjusted odds ratio 0.89, 95% confidence interval 0.89–0.90), age of death (6–10 year-olds 21.46, 16.42–28.04, reference neonates), semester of death (October–March 1.18, 1.05–1.32, reference April–September), and cause of death (neuromuscular diseases 1.59, 1.37–1.84, reference cancer), with wide regional variation.Conclusions
This first trend analysis of paediatric deaths in Portugal (an European country without paediatric palliative care) shows that palliative care needs are increasing. Children are surviving longer and, in contrast with countries where paediatric palliative care is thriving, there is a long-term trend of dying in hospital instead of at home. Age, diagnosis, season and region are associated with home death, and should be considered when planning services to support families choosing this option. Priorities should address needs of the youngest children, those with cancer, neuromuscular and cardiovascular conditions, as well as inequities related to place of residence.4.
5.
Barbara?CvenkelEmail author 《Albrecht von Graefes Archiv fur klinische und experimentelle Ophthalmologie》2004,242(11):920-925
Purpose Ganglion cells with nerve fibre layer contribute a substantial fraction to the retinal thickness (RT). In contrast to the analysis of papillary and peripapillary area, which have shown large variability in normal eyes, the variation of retinal cell density in the perifoveal region is reported to be less than 10%. By measuring RT at the posterior pole we wanted to detect retinal changes due to glaucoma and determine their correspondence with visual field (VF) changes.Methods The Retinal Thickness Analyzer (RTA) was used to obtain RT maps in 21 normal eyes, 20 eyes with ocular hypertension and 22 eyes with glaucoma. A green laser slit (540 nm) of the RTA was focused on the retina at an angle and its intersection with the retina was imaged. The distance between the reflections from the vitreo–retinal and retina–retinal pigment interface is directly proportional to the RT. Five locations covering the central 20° were scanned, generating 10 optical cross sections that were transformed into colour-coded RTA maps. Numerical data were presented for the perifoveal and posterior pole region.Results In glaucomatous eyes significant localised thinning of the retina was present, identified as the increased number of clusters including at least four points that are 2 standard deviations below normal. The minimum retinal thickness was decreased in glaucoma eyes and the perifoveal temporal modulation and perifoveal temporal/nasal asymmetry—indicators of greater RT loss in the temporal and the nasal quadrant, respectively—were higher in eyes with glaucoma, but with overlapping global indices between the groups. In 16 of 22 eyes with glaucoma there was good agreement of RT changes with VF defects. In two eyes with typical glaucomatous damage at the optic disc but without VF defects localised changes of RT were detected.Conclusions The RTA enables objective noninvasive evaluation of the posterior pole and could become helpful in diagnosis of glaucoma before the onset of functional damage. However, at present its clinical usefulness is limited by overlapping values of retinal thickness between normal and glaucomatous populations. 相似文献
6.
a. latiano r. de giorgio † u. volta ‡ o. palmieri c. zagaria v. stanghellini † g. barbara † a. mangia a. andriulli r. corinaldesi † & v. annese 《Neurogastroenterology and motility》2006,18(7):520-525
The aetiopathogenesis of primary achalasia is largely unknown, although an immunogenetic predisposition is suspected. To establish whether a correlation exists among possible aetiological factors, including class II human leucocyte antigen (HLA) alleles and autoantibodies to enteric neurones, and clinical features of patients with achalasia, a total of 60 patients and 200 healthy subjects were typed by high-resolution HLA-DQ and HLA-DR alleles. Circulating antineuronal antibodies were investigated by using indirect immunofluorescence on enteric neurones of rat ileum and colon and immunoblotting assay in a subset of achalasic patients and in all controls. The DQB1*0502 and DQB1*0601 alleles were significantly increased in patients with achalasia compared with controls (P < 0.03, P < 0.001, respectively). Moreover a negative correlation with the DQB1*0201 allele was found (P = 0.016). As a whole, 14 of 60 (23.3%) achalasia patients were carriers of HLA risk alleles, and 10 of 41 (24.4%) presented antineuronal antibodies. No significant correlation among HLA risk alleles, antineuronal antibodies and clinical features was found. In achalasia, no correlation exists among HLA alleles, antineuronal antibodies and clinical features. However, given the association between achalasia and HLA-DQ1, further research is needed to clarify the role of HLA antigens and antineuronal antibodies in this disease. 相似文献
7.
Alemtuzumab in previously treated chronic lymphocytic leukemia patients who also had received fludarabine. 总被引:13,自引:0,他引:13
K R Rai C E Freter R J Mercier M R Cooper B S Mitchell E A Stadtmauer P Santábarbara B Wacker L Brettman 《Journal of clinical oncology》2002,20(18):3891-3897
PURPOSE: This phase II pilot study determined the efficacy and safety of alemtuzumab (Campath-1H; Burroughs Wellcome, United Kingdom) in patients with chronic lymphocytic leukemia (CLL), all of whom had previously received fludarabine and other chemotherapy regimens. PATIENTS AND METHODS: Twenty-four patients were treated with intravenous alemtuzumab at six centers in the United States. The target dose of 30 mg over 2 hours, three times weekly, was administered for up to 16 weeks. Responses were evaluated by an independent panel of experts using 1996 National Cancer Institute-sponsored Working Group criteria. Safety assessments included analysis of lymphocyte subpopulations. Antimicrobial prophylaxis was not mandatory. RESULTS: Eight patients (33%) achieved a major response (all partial remissions), with a median time to response of 3.9 months (range, 1.6 to 5.3 months). The median duration of response was 15.4 months (range, 4.6 to >or= 38.0 months), the median time to disease progression was 19.6 months (range, 7.7 to >or= 42.0 months), and the median survival time was 35.8 months (range, 8.8 to >or= 47.1 months). Acute infusion-related events, mainly grades 1 and 2, were most common and most severe in the first week. Ten patients (eight nonresponders and two responders) experienced major infections on-study. Pneumocystis carinii pneumonia was reported in two patients on-study; neither had received prophylaxis. Median CD4+ and CD8+ counts decreased and then began to increase by the end of the study, with further recovery by 1-month follow-up. One of 53 samples obtained from 10 patients had a low titer of alemtuzumab antibodies. CONCLUSION: Alemtuzumab has significant activity in poor-prognosis, fludarabine-treated CLL patients. However, because of a relatively high incidence of opportunistic infections accompanying profound lymphopenia, future protocols should include mandatory prophylaxis. 相似文献
8.
Rational
Negative symptoms of schizophrenia are insufficiently treated by current antipsychotics. However, research is limited by the lack of validated models. Clinical data indicate that phencyclidine (PCP) abuse may induce symptoms resembling negative symptoms in humans. Based on that, Noda et al. proposed a model of PCP-induced increase of immobility in the forced swim test in mice as a model of depression-like negative symptoms of schizophrenia. 相似文献9.
Exercise slips in high-risk situations and activity patterns in long-term exercisers: An application of the relapse prevention model 总被引:2,自引:0,他引:2
Barbara?A.?StetsonEmail author Abbie?O.?Beacham Stephen?J.?Frommelt Kerri?N.?Boutelle Jonathan?D.?Cole Craig?H.?Ziegler Stephen?W.?Looney 《Annals of behavioral medicine》2005,30(1):25-35
Background: Key factors in successful long-term exercise maintenance are not well understood. The Relapse Prevention Model (RPM) may
provide a framework for this process.Purpose: The purpose of this study was to examine the relationships among characteristics of exercise high-risk situations, components
of the RPM relevant to exercise slips, and follow-up exercise outcomes in long-term community exercisers.Methods: We obtained long-term exercisers’ (N=65) open-ended responses to high-risk situations and ratings of obstacle self-efficacy,
guilt, and perceived control. High-risk situation characteristics, cognitive and behavioral coping strategies, and exercise
outcomes were examined.Results: High-risk situation characteristics included bad weather, inconvenient time of day, being alone, negative emotions, and fatigue.
Being alone was associated with lower incidence of exercise slip. Positive cognitive coping strategies were most commonly
employed and were associated with positive exercise outcome for both women and men. Guilt and perceived control regarding
the high-risk situation were associated with exercise outcomes at follow-up, but only among the men (n=28).Conclusions: Findings confirm and extend previous work in the application of the RPM in examining exercise slips and relapse. Measurement
issues and integration approaches from the study of relapse in addiction research are discussed. 相似文献
10.
Rinet?Dauti Barbara?CviklEmail author Alexander?Franz Uwe Yacine?Schwarze Bledar?Lilaj Tina?Rybaczek Andreas?Moritz 《BMC oral health》2016,16(1):129