conclusion: stroke rates are lower with percutaneously implanted device closure than with medicaltherapy alone. As we know, the medical literature currently changes at a fast pace. No sooner had all these meta-analyses been published than a new trial (DEFENSE- PFO) came out. Therefore, it is necessary to constantly review the current published medical data with regard to this subject.
Materials and Methods: A retrospective chart review was performed to identify obese patients with stone disease from our Stone Center. Metabolic risk factors for stones were identified as well as patient response to medicaltherapy. A similar analysis was performed on a group of age and sex matched nonobese stone formers.
assigned 100 patients to medicaltherapy or TMLR using symptoms, physical ability and maximum oxygen consumption as measured by the exercise test as the primary endpoint. Although angina scores were better in the TMLR group in relation to the group medically treated, the objective parameters of physical ability such as treadmill time and maximum oxygen consumption were not different between the groups. Morbidity and mortality after one year was similar between the two groups. No change in the ejection fraction was observed one year after the procedure. The authors mention that “cardiac laser treatment” (rejecting the term ‘transmyocardial revascularization’) may work in the reduction of symptoms but “there is no convincing evidence that it improves cardiac function or reduces the number of ischemic events”. They acknowledge that double-blind, placebo- controlled studies with PMLR are essential to assess the role of the “placebo effect” in the results of the procedure.
treatment for otomycosis. Topical ketoconazole, tolcicla- te, polymyxin B sulfate and neomycin were attempted, together with ciprofloxacin, metronidazole and sulpha- metoxazol/trimethoprim, without improvement. The first examination revealed a suppurating ear with posterior perforation of the tympanic membrane, which was necrotic throughout. The patient was medicated with topical and oral ciprofloxacin. One week later there was a fungal co- lony in the canal and over the hammer. The colony was removed, and necrosis was noted in part of the hammer and the external auditory canal. The patient reported pain over the mastoid; thus, a biopsy was made of the necrotic material and the patient was treated with oral fluconazole and six injections of ceftriaxone. Pathology showed a chronic inflammation with ulcers, suppuration and fungi. A swab of the secretion revealed no alcohol-acid resistant bacilli. Computed tomography of the temporal bone revea- led opacification of the mastoid cells with no bone erosion. One month later there was still suppuration, the tympanic membrane was absent, part of the hammer was eroded and the promontory had granulation tissue and a fungal colony. Audiometry showed severe mixed hearing loss at low frequencies and moderate hearing loss at middle fre- quencies. The chest X-ray was suggestive of tuberculosis. The patient was referred to a pneumologist who started therapy with isoniazid, rifampicin and flixotide during six months. One year later, the patient was discharged from the medical treatment. The ears had no secretions, there was hearing loss, full loss of the tympanic membrane and partial loss of the ossicles. Tympanoplasty was under- taken after one year of no active disease. The head of the hammer was removed and the anvil was interposed over the head of the stirrup; a perichondral graft was used for rebuilding the membrane. The patient was reoperated six months later to close to minor marginal perforations. The patient was finally discharged from medicaltherapy eight months later; the tympanic membrane was complete and there was mixed moderate hearing loss at low frequencies and mild loss at high frequencies.
has become standard medicaltherapy, reducing the risk of stroke by ~60%. Nonetheless, the long-term use of warfarin carries several drawbacks and complications, including non-tolerance, non-adherence, interactions with food and other medications, a very narrow therapeutic range, and an increased risk of bleeding 3 . In addition, oral anticoagulation
Introduction: Patent foramen ovale is a common congenital cardiac anomaly with a high prevalence in general population (≈25%). In most patients is an isolated finding with no need for special treatment. However, this entity has been associated to a number of major pathologic conditions, such as: systemic paradoxical embolism, migraine, decompression illness in divers and orthodeoxia-platypnea syndrome. It is more prevalent among patients with stroke under 50 years old and appears to have no difference between race or sex. Although numerous observational studies have suggested a strong association between patent foramen ovale and cryptogenic stroke, a clear relationship has not yet been proven. Echocardiographic techniques remain the principle mean for diagnosis. Even if patent foramen ovale is shown to predispose to stroke, medical therapies for stroke prevention in these patients have not been adequately tested, making comparisons with invasive treatment difficult. The preference between medicaltherapy and percutaneous device closure has been the subject of intense debate over the past several years.
We present a case of severe fungal infection of the cornea in which systemic oral voriconazole was used as an adjunct therapy after conventio- nal antifungal medicaltherapy failure. This case report may warrant additio- nal investigation on the role of this anti-fungal agent to treat severe myco- tic corneal infection.
Most studies with steroidogenesis inhibitors have been carried out with metyrapone and ketoconazole (27-31). Metyrapone treatment leads to marked inhi- bition of aldosterone biosynthesis, and accumulation of aldosterone precursors with weak mineralocorticoid ac- tivity. Blood pressure levels and electrolyte balance vary individually with the degree of aldosterone inhibition and 11-deoxycorticosterone (DOC) stimulation. Ad- verse effects due to increased DOC levels (hypokalemia, edema, hypertension) are infrequent (31). Metyrapone is not commercially available in Brazil. Ketoconazole is usually the irst choice. Widely available, and generally well tolerated, it was our choice to control Cushing symptoms since the beginning of the case. Mild eleva- tion in liver enzymes (up to three-fold normal levels), which are transient, is not a contraindication to medicaltherapy with ketoconazole. Liver function should be carefully monitored because of the rare complication of liver failure (32). In our case, for several years, this drug was well tolerated and actually controlled hypercorti- solemia. However, on the very last days, liver enzymes rose 100 times above the normal range. It is possible that drug interaction contributed to this outcome.
In obese patients with uncontrolled type 2 diabetes, 3 years of intensive medicaltherapy associated with bariatric sur- gery resulted in glycemic control in significantly more pa- tients than medicaltherapy alone. Analyses of secondary endpoints, including body weight, use of hypoglycemic medication and quality of life also showed favorable re- sults after 3 years in the groups of surgery compared to the group receiving medical treatment alone.
Bladder contracture is a rare complication that must be thought of in patients with severe lower urinary tract symptoms and on Bacillus Calmette-Guérin therapy. When medicaltherapy is not possible, surgical approach with cystoprostatectomy and neobladder is the best option, for being a definite treatment and providing improved quality of life.
Purpose: Comparison of laser therapy (LT ) outcomes in patients with retinopathy of prematurity (ROP) followed up in our clinic and referred from other centers. Methods: Medical records of 1,856 ROP patients were retrospectively evaluated, and a total of 128 patients who underwent LT were included in the study. The study population was divided into the following two groups: patients who were followed up and treated in our clinic (group 1, N=45) and patients who were referred to our clinic from other centers (group 2, N=83). Data regarding birth weight, sex, gestational age, postnatal treatment time, disease localization, and stage were analyzed and compared between the two groups. Treatment success was defined by anatomic success 6 months after treatment.
this was a descriptive, cross-sectional, epidemiological, population study developed in 2015. The sample for this study was obtained by convenience and comprised students in the healthcare area (medicine and physical therapy), without distinction of sex or ethnicity, at a private institution of higher education. These students agreed to fill out the questionnaire voluntarily according to their time availability, without interfering with their daily and academic activities. The Fantastic instrument, used in this study, comprises 25 closed questions that explore nine domains on physical, psychological, and social lifestyle components, identified with the acronym FANTASTIC: F - family and friends, A - physical activity/affiliation, N - nutrition, T - tobacco, A - alcohol and other drugs, S - sleep/stress, T - work/type of personality, I - insight, and C - health and sexual behaviors. The items have five options as answers, with numeric values ranging from 0 to 4. The sum of the scores from all domains derives the global score, which ranges from 0 to 100 points, stratifying the individual into five levels of behavior: 0 to 34 (needs
Jacobson and Newman (1990), creators of the DHI, developed this test that is composed of 25 questions - based on reports of patients with dizziness - aimed at quantifying behavioral changes resulting from therapy, and gaining useful information for planning the clinical strategy. The questionnaire assesses physical, emotional and functional aspects; scores range from 0 (zero) points for the answer “no”, 2 points for the answer “sometimes”, and 4 points for the answer “yes”. 11 The difference between
Eponyms can take decades to be commonly accepted, which is not necessarily a bad thing. Many eponyms have been identified after the death of the eponym name- sake, when rediscovered by a secondary investigator who posthumously connects it with the individual who ‘wrote it up’. Eponyms often reflect the dominance of scientific cultures and languages at the time. Eponyms flourished from the late 19th to early 20th centuries when the lead- ing scientific languages were English and German. A good example of the eponym process is the entity of acute adrenal failure secondary to meningococcemia, referred to as adrenal apoplexy. Numerous case reports of this entity were published around 1900 mostly in obscure medical journals following autopsies that revealed adrenal (or ‘suprarenal’) fatal hemorrhage complicating sepsis (3). In 1911, British physician Rupert Waterhouse pub- lished in Lancet, the leading English language journal at the time, a fulminant fatal case report (4). In 1917 and 1918, Carl Friderichsen published two cases and a review of the literature in Danish and German (5). In 1933, Eduard Glanzmann, in a clinical review, gave it the name of WaterhouseFriderichsen syndrome (6).
In this century, cancer incidence has become one of the most significant problems concerning human. Conventional radiotherapy damage healthy tissue and in some cases may cause new primary cancers. This problem can be partially solved by hadron therapy which would be more effective and less harmful compared to other forms of radiotherapies used to treat some cancers. Although carbon ion and proton therapy both are effective treatments, they have serious differences which are mentioned in this paper and compared between the two methods. Furthermore, various treatments have been performed on head and neck cancer with hadrons so far will be discussed. Keywords: cancer; proton therapy; carbon ion therapy; Boron neutron capture therapy (BNCT); head; neck
replacement therapy. Generally, two replacement strategies have been used and they do not include glucocorticoids during anesthetic induction. In one strategy, routine replacement therapy is not performed during the immediate PO period and in the initial days. Despite the short half-life of cortisol (range, 50–70 minutes) and intense reduction of its serum concentration after a successful adenoma removal, the patient does not usually show adrenal insufficiency too early – 24-48 hours – after surgery (48-50). Thus, the measurement of morning cortisol or a 6/6-hour curve starting in the immediate PO period is performed during the first days, and glucocorticoid replacement is initiated only after suggestive symptoms of adrenal insufficiency (with measurement being performed immediately before) and/or when low levels of cortisol are detected (< 5 µg/dL). Endocrinologists should closely assess the patient, if possible, until replacement is initiated. In this strategy, one advantage is that serum cortisol measurements are not influenced by exogenous corticosteroids. The second strategy consists of initiating routine glucocorticoid replacement therapy during the immediate PO period, preferably with short half-life corticoids, such as hydrocortisone (immediate PO, 25–50 mg intravenously three times per day), followed by oral hydrocortisone (from the 1 st PO
hyperlipidemia, hyperuricemia, hypokalemia and hypomagnesemia are all metabolic, dose-dependent side effects induced by thiazide diuretics. Therefore, limiting the dose administered to decrease calciuria sounds reasonable. However, a small study with 6 non-stone formers subjects could not show a statistically significant reduction in urinary calcium with 12.5 mg/day of hydrochlorothiazide, 25 mg/ day showed some response and doses of 50 mg/day showed the most significant reduction in urinary calcium. 34 Additionally, thiazide therapy may induce