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Angiomyolipomatous hamartoma of the upper lip: a rare case in an 8-month-old child and differential diagnosis.
Journal: Journal of cranio-maxillo-facial surgery : official publication of the European Association for Cranio-Maxillo-Facial Surgery
July/18/2011
Description

Hamartoma is a proliferation of normal tissues that are considered endogenous to the site of occurrence. In the head and neck region, hamartomas composed of other tissues different from blood and lymphatic vessels (hemangiomas and lymphangiomas) are very uncommon. We report an unusual case of upper lip angiomyolipomatous hamartoma in an 8-month-old patient. The patient underwent surgical treatment and the 1-year follow-up revealed no signs of recurrence. Angiomyolipomatous hamartoma is a very rare condition in the paediatric population group, especially in the head and neck region. It should be considered in the differential diagnosis of congenital lesions in childhood.

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Serum calcium is not predictive of aggressive prostate cancer after radical prostatectomy.
Journal: Urology
July/18/2011
Description

OBJECTIVE

To investigate the effect of preoperative total serum calcium on disease progression after radical prostatectomy (RP). Elevated total serum calcium has been linked to death from prostate cancer in the National Health and Nutrition Examination Surveys I and II. However, these findings have not been studied in a large cohort of patients with prostate cancer.

METHODS

We identified 10,532 consecutive patients who had undergone RP from 1990 to 2004 for prostate cancer. Total serum calcium levels were available for 7648 (72.6%) of these patients within 90 days before RP. Postoperative survival was estimated using the Kaplan-Meier method and compared using the log-rank test. Cox proportional hazard regression models were used to analyze the ability of serum calcium to predict biochemical recurrence, systemic progression, and cancer-specific survival.

RESULTS

The median patient age at surgery was 64 years. The median total serum calcium level was 9.4 mg/dL (range 6.8-11.2). On univariate analysis, the total serum calcium level was not significantly associated with any clinical or pathologic variables, including tumor stage, preoperative prostate-specific antigen, Gleason score, tumor volume, surgical margins, or lymph node status. Furthermore, the serum calcium level was not significantly associated with biochemical failure, systemic progression, or prostate cancer death on univariate or multivariate analysis.

CONCLUSIONS

The total serum calcium level was not predictive of cancer outcomes in patients who had undergone RP. Additional investigations of the preoperative disease predictors after RP for patients with nonmetastatic disease might be better directed toward other markers.

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Diagnosis and management of primary aldosteronism.
Journal: The Nurse practitioner
July/21/2011
Description

Primary aldosteronism (PAL) is characterized by excessive production of aldosterone, which leads to hypernatremia, hypertension (HTN), hypokalemia, and alkalosis. Three crucial diagnostic steps include case detection, case confirmation, and subtype classification. Marked improvement or cure of HTN is achieved with appropriate treatment.

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Synthesis of complementary double-stranded helical oligomers through chiral and achiral amidinium-carboxylate salt bridges and chiral amplification in their double-helix formation.
Journal: Journal of the American Chemical Society
June/27/2011
Description

A series of complementary molecular strands from 2-mer to 5-mer that are composed of m-terphenyl units bearing chiral/achiral amidine or achiral carboxyl groups linked via Pt(II) acetylide complexes were synthesized by sequential stepwise reactions, and their chiroptical properties on the double-helix formation were investigated by circular dichroism (CD) and (1)H NMR spectroscopies. In CHCl(3), the "all-chiral" amidine strands consisting of (R)- or (S)-amidine units formed preferred-handed double helices with the complementary achiral carboxylic acid strands through the amidinium-carboxylate salt bridges, resulting in characteristic induced CDs in the Pt(II) acetylide complex regions, indicating that the chiral substituents on the amidine units biased a helical sense preference. The Cotton effect patterns and intensities were highly dependent on the molecular lengths. The complementary double-helix formation was also explored using the chiral/achiral amidine strands with different sequences in which a chiral amidine unit was introduced at the center (center-chiral) or a terminus (edge-chiral) of the amidine strands. The effect of the sequences of the chiral and achiral amidine units on the amplification of chirality (the "sergeants and soldiers" effect) in the double-helix formation was investigated by comparing the CD intensities with those of the corresponding all-chiral amidine double helices with the same molecular lengths. Variable-temperature CD experiments of the all-chiral and chiral/achiral amidine duplexes demonstrated that the Pt(II)-linked complementary duplexes are dynamic and their chiroptical properties including the chirality transfer from the chiral amidine unit to the achiral amidine ones are significantly affected by the molecular lengths, sequences, and temperatures. On the basis of the above results together with molecular dynamics simulation results, key structural features of the Pt(II)-linked oligomer duplexes and the effect of the chiral/achiral amidine sequences on the amplification of chirality are discussed.

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The utility of polyester and cotton as swabbing substrates for the removal of cellular material from surfaces.
Journal: Journal of forensic sciences
June/27/2011
Description

Various types of cotton and polyester fabrics were tested to ascertain the optimal physical and chemical characteristics of fabrics needed for the removal of cellular material from surfaces. DNA quantitation values obtained on dried saliva stains showed no difference between cotton and polyester across all constructions and solvent conditions. Fabrics used dry and with water yielded higher quantitation values than those used with isopropanol. Quantitation values were also higher for wovens and nonwovens than knits across all solvent conditions. Low thread count fabrics used with water yielded higher quantitation values, but no correlation between thread count and quantitation values was observed with dry fabrics. A low thread count woven fabric, however, outperformed other tested fabrics when swabbing object surfaces in a highly used room. Full DNA profiles from fingerprints on glass surfaces were obtained with low thread count woven and nonwoven fabrics but not with the knit fabric tested.

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Photoinduced decarboxylation of 3-(N-phthalimido)adamantane-1-carboxylic acid and radical addition to electron deficient alkenes.
Journal: Photochemical & photobiological sciences : Official journal of the European Photochemistry Association and the European Society for Photobiology
July/11/2011
Description

Direct and sensitized excitation of 3-(N-phthalimido)adamantane-1-carboxylic acid (1) leads to the population of the triplet state that, in the presence of a base, decarboxylates, giving N-(1-adamantyl)phthalimide (2) cleanly and efficiently (Φ = 0.11). The radical initially formed by decarboxylation adds regiospecifically to electron deficient alkenes, whereas radical addition was not observed for electron rich alkenes. The radical addition can also be applied to molecules not bearing adamantanes wherein the electron donor (carboxylate) and the acceptor (phthalimide) are separated by a rigid spacer. The photodecarboxylation induced radical addition of phthalimide derivative 1 to alkenes takes place in good to excellent yields and represents a mild and efficient method for C-C bond formation.

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Cognitive neuroscience: distinguishing self from other.
Journal: Current biology : CB
July/11/2011
Description

Neurons in medial frontal cortex have been found to distinguish between whether an animal or its partner is responding on a turn-taking task, but are they really the basis of a social learning mechanism?

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Analyses of clinical, pathological and virological features of human rotavirus strain, YO induced gastroenteritis in infant BALB/c mice.
Journal: Microbes and infection
June/30/2011
Description

Experimental studies of human rotavirus infections in mice are limited and there is lack of information on the quantitative assessment of rotaviral replication and its relationship with histological changes. In the present study, consequences of human rotavirus strain, YO induced gastroenteritis in infant BALB/c mice were analyzed for the occurrence of clinical symptoms, histopathology and virological events. The infected animals developed diarrhea and dehydration and showed accumulation of vacuolated enterocytes with lodging of the rotavirus antigens and shortening of villi in the intestine over a period of 5 days. The ileum was identified as the most susceptible and supportive part of small intestine for perpetuation of rotavirus infection in mice. Rotaviral antigen/RNA in stool and RNA in intestine were detected throughout the clinical disease period. At 48-72 h post inoculation, diarrhea was at the peak (90-95%) in the infected animals with increased load of viral RNA and intense pathological lesions suggesting it as the critical time point in the course of infection. The rising titers of antirotavirus neutralizing antibodies ascertained the replication of human rotavirus strain, YO in mice. These data may contribute to the understanding of pathophysiological, immunological and virological characteristics of rotavirus infections in mice.

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Pubmed
Primary retroperitoneal dysgerminoma presenting as an adrenal tumor: a case report and literature review.
Journal: Pathology international
July/12/2011
Description

Primary extragonadal germ cell tumors are rare and mostly occur in young men with predominance of nonseminomatous histology. We report an undescribed case of primary retroperitoneal dysgerminoma presenting as an adrenal tumor in a 17-year-old girl. Surgery was performed on a 10 × 9.5 cm sized adrenal gland tumor and the resected tumor showed unequivocal histological features of dysgerminoma. The diagnosis was confirmed by the tumor's germ cell immunophenotype. Postoperative ultrasonography, CT and PET over a 6-month period revealed no evidence of ovarian lesion. The patient is stable, but with a suspicious residual tumor after adjuvant chemotherapy.

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Epidemiological analysis of notified measles cases and review of surveillance system during an outbreak in Tabuk, Saudi Arabia.
Journal: Annals of epidemiology
June/21/2011
Description

OBJECTIVE

In response to a measles outbreak occurred in Tabuk, Saudi Arabia, we conducted a case-based active-surveillance, and analyzed all surveillance data to identify the epidemiology of notified measles cases and to review the surveillance system.

METHODS

Suspected and confirmed measles cases were defined according to World Health Organization (WHO) guidelines. Household-based investigation was conducted for all suspected cases using standard measles notification form. Enzyme-linked immunosorbent assay was carried out on serum samples collected from all suspected cases to detect measles specific immunoglobulin M (IgM) antibodies. Surveillance system was assessed by preselected performance indicators consistent with WHO guidelines. Logistic regression was used to calculate crude and adjusted odds ratios from the surveillance data.

RESULTS

Of 242 suspected measles cases notified between 3rd and 48th calendar weeks of the study-year, laboratory result was IgM-positive for 46% cases, IgM-negative for 49% cases, and unknown for 5% cases. Suspected and confirmed cases separately showed urban-predominance (>77%), male-majority (>51%), and high-proportion among Saudis (>92%). The highest proportion (93%) of suspected cases that received "at least one dose" of measles-containing vaccine (MCV) was found among those aged 12-17 years, whereas the lowest proportion (17%) was observed among the adult individuals (> or =18 years). Elderly (> or =18 years) individuals were significantly less likely to be vaccinated than younger (1-5 years) children (adjusted odds ratio [OR] = 15.92, 95% confidence interval [CI] = 4.82-52.56). The vaccine failure rate for "at least one dose" of MCV was 35%. The individuals vaccinated with "at least one-dose" of MCV were at 3.6 times lower risk of contracting measles than the nonvaccinated group (adjusted OR = 3.6, 95% CI = 1.55-8.38). Of five surveillance performance indicators, three were found as per WHO target.

CONCLUSIONS

More efforts are essential to prevent future outbreaks and to reach the goal of measles elimination in the country.

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Rapid analysis of dried blood spot samples with sub-2-µm LC-MS/MS.
Journal: Bioanalysis
June/21/2011
Description

The use of dried blood and dried plasma spots for storage and transportation of samples derived from clinical trials holds the promise to reduce cost, simplify storage and shipping as well as reducing animal usage. From the bioanalysts' point of view, these dried-paper samples add an extra layer of complexity to the analysis introducing extra matrix effects from the paper itself and sometimes from antiviral treatments applied to the card. In this article we demonstrate the use of the sub-2-µm particle LC-MS/MS for the bioanalysis of samples derived from a dried blood spot. The higher resolution provided by these small-particle separations allowed for greater resolution of the analyte from the endogenous components in blood samples and from the card-treatment chemicals. The method-development process was enhanced by the use of MS, which could simultaneously acquire full scan and multiple reaction monitoring data, allowing resolution from metabolites and endogenous matrix components. The use of this approach produced sensitivity levels in the 50-100 pg/ml range and analysis times in the 1-2 min range, which was five-times more sensitive and three-times faster than HPLC. This throughput and sensitivity makes this approach ideal for the analysis of preclinical and clinical studies derived from dried blood spots.

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Effective scattering phase functions for the multiple scattering regime.
Journal: Optics express
June/22/2011
Description

The propagation of light through turbid media is of fundamental interest in a number of areas of optical science including atmospheric and oceanographic science, astrophysics and medicine amongst many others. The angular distribution of photons after a single scattering event is determined by the scattering phase function of the material the light is passing through. However, in many instances photons experience multiple scattering events and there is currently no equivalent function to describe the resulting angular distribution of photons. Here we present simple analytic formulas that describe the angular distribution of photons after multiple scattering events, based only on knowledge of the single scattering albedo and the single scattering phase function.

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Large-area burns with pandrug-resistant Pseudomonas aeruginosa infection and respiratory failure.
Journal: Chinese medical journal
June/22/2011
Description

BACKGROUND

Infection due to pandrug-resistant Pseudomonas aeruginosa (PDRPA) has become a challenge in clinical practice. The aim of this research was to summarize the treatment of large-area burns (60% - 80%) with PDRPA infection and respiratory failure in our hospital over the last two years, and to explore a feasible treatment protocol for such patients.

METHODS

We retrospectively analyzed the treatment of five patients with large-area burns accompanied by PDRPA infection and respiratory failure transferred to our hospital from burn units in hospitals in other Chinese cities from January 2008 to February 2010. Before PDRPA infection occurred, all five patients had open wounds with large areas of granulation because of the failure of surgery and dissolving of scar tissue; they had also undergone long-term administration of carbapenems. This therapy included ventilatory support, rigorous repair of wounds, and combined antibiotic therapy targeted at drug-resistance mechanisms, including carbapenems, ciprofloxacin, macrolide antibiotics and β-lactamase inhibitors.

RESULTS

Four patients recovered from burns and one died after therapy.

CONCLUSIONS

First, compromised immunity caused by delayed healing of burn wounds in patients with large-area burns and long-term administration of carbapenems may be the important factors in the initiation and progression of PDRPA infection. Second, if targeted at drug-resistance mechanisms, combined antibiotic therapy using carbapenems, ciprofloxacin, macrolide antibiotics and β-lactamase inhibitors could effectively control PDRPA infection. Third, although patients with large-area burns suffered respiratory failure and had high risks from anesthesia and surgery, only aggressive skin grafting with ventilatory support could control the infection and save lives. Patients may not be able to tolerate a long surgical procedure, so the duration of surgery should be minimized, and the frequency of surgery increased.

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The fetal safety of hydrocortisone-pramoxine (Proctofoam-HC) for the treatment of hemorrhoids in late pregnancy.
Journal: Journal of obstetrics and gynaecology Canada : JOGC = Journal d'obstetrique et gynecologie du Canada : JOGC
July/10/2011
Description

OBJECTIVE

Fetal safety has never been studied for any drug used in the treatment of hemorrhoids. Proctofoam-HC is a combination of a corticosteroid and a local anaesthetic that is proven effective for the treatment of hemorrhoids. The objective of this study was to assess prospectively the fetal safety of third trimester exposure to Proctofoam-HC.

METHODS

In a multicentre study, 204 [corrected] women exposed to Proctofoam-HC in the third trimester and a similar number of control pregnant women were followed up postnatally.

RESULTS

When compared to controls exposure to Proctofoam-HC was not associated with any adverse fetal effects on birth weight, gestational age, rates of prematurity, or pre- or postnatal complications.

CONCLUSIONS

Proctofoam-HC is safe to use in the treatment of hemorrhoids in late pregnancy.

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Environmental surveillance and molecular characterization of Legionella in tropical Singapore.
Journal: Tropical biomedicine
August/30/2011
Description

Legionnaires' disease is often acquired by inhalation of legionellae from a contaminated environmental source. In recent years, Singapore has seen an increase in the use of aerosol-generating fixtures such as mist fans and spa pools. Poorly maintained and designed water fixtures could pose a public health threat to the community. In this study, we provided an update on the prevalence of Legionella in mist fans (N=28), household water heaters with storage tanks (N=19) and instantaneous heaters (N=30); and extended the survey to spa pools (N=29) and aerosol-generating fixtures in nursing homes (N=116). The prevalence of Legionella were 21.1% in water heaters with storage tanks, 24.1% in spa pools, 14.2% in mist fans and 3.3% in instantaneous heaters. Legionella was not detected in nursing homes. A total of 37 isolates were subjected to molecular characterization using Sequence-Based Typing (SBT) protocol from the European Working Group on Legionella Infections (EWGLI). This is the first study on the use of SBT protocol on environmental strains isolated from tropical South East Asia. The Legionella flora was very heterogenous. The overall diversity of the allelic profile was found to be 0.970 (95% CI 0.946 - 0.994). All known STs of our isolates have been associated with clinical cases in EWGLI database. The phylogenetic analysis showed that our novel environmental isolates were clustered with clinical STs that were previously reported in Europe, Japan, United Kingdom and United States etc. (in EWGLI database), suggesting that Legionella found in the environment of Singapore may potentially cause human disease.

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Feasibility of pancreaticoduodenectomy in a nonuniversity tertiary care center: what are the key elements of success?
Journal: The American surgeon
August/30/2011
Description

It is advocated that a favorable outcome for pancreaticoduodenectomy (PD) is related to a high volume at university centers. This article examines the specific elements that allow an equivalent outcome from PD in a nonuniversity tertiary care center (NUTCC). The study was performed to: (1) evaluate the outcome of PDs done at a NUTCC; (2) study the components of the process that are required to attain success in a NUTCC; and (3) provide a new look at the volume-outcome relationships in complex surgeries in a novel nonuniversity setting. Medical records of patients who underwent PD by a single surgeon between September 2005 and August 2008 at a high-volume NUTCC were analyzed. The records were reviewed with respect to preoperative and postoperative data, 30-day mortality, morbidity, and histopathology data. A total of 122 patients underwent PD. The mean age was 68.2 years. Jaundice was the most common presenting symptom in 57 per cent (69 patients). Thirty-nine patients (32%) underwent a pylorus-preserving PD. The mean operative time was 237 minutes. The mean estimated blood loss was 480 mL. The mean length hospital stay was 13 days. Thirty-day mortality was 3.2 per cent (four patients) and overall morbidity was 49 per cent. The key factors in developing a team dedicated to the care of the patient undergoing PD are discussed. A center of excellence can be developed in a NUTCC resulting in outcomes that meet and indeed may exceed nationally reported benchmarks. The key elements to success include a team approach to the patient undergoing PD.

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Home health care--the long view.
Journal: Caring : National Association for Home Care magazine
September/12/2011
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Delineation of an epitope on domain I of Japanese encephalitis virus Envelope glycoprotein using monoclonal antibodies.
Journal: Virus research
September/7/2011
Description

The Envelope glycoprotein (E-protein) of Japanese encephalitis virus (JEV) is the major structural component on the virion surface and is a primary target for the host immune system. Two monoclonal antibodies (MAbs) NHA-I (IgG2b) and NHA-II (IgM) against JEV (Indian strain 733913) were earlier developed in the authors' laboratory and found to be cross-reactive to nuclear histones. However, the epitope specificity of these MAbs has remained unknown. The present study was carried out to delineate the epitopes recognised by these MAbs on the E-protein of JEV strain 733913. The variable regions of the NHA-I and NHA-II were sequenced and the tertiary structures predicted. Molecular docking of the MAbs with the structural model of the JEV E-protein demonstrated that NHA-I binds to a predicted antigenic determinant (residue position 18-33) in domain-I. To understand the epitope specificity and check for possible cross-reactivity of these MAbs, comparative analysis of interactions with the known crystallographic structure of the West Nile virus (WNV) E-protein was also carried out. The studies predicted a differential binding of NHA-I but not of NHA-II between JEV and WNV. Mutagenesis studies could help analyse the specificity of NHA-I. The NHA-II appears to be cross-reactive as it docked in the groove region between domains I and III of both the JEV and WNV E-proteins. In laboratory assays, namely, ELISA and immunofluorescence assay both the MAbs reacted equally with JEV while the NHA-I did not show any reactivity with WNV. In silico results were thus validated by laboratory experiments. The present study would help in better understanding of virus-host interactions at the molecular level, and also be useful for the future design of vaccines as well as peptide based diagnostics.

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Enhanced protection of mice against Japanese encephalitis virus infection by combinations of monoclonal antibodies to glycoprotein E.
Journal: Acta virologica
September/14/2011
Description

In the present study, the protective effect of various combinations of four monoclonal antibodies (MAbs) to glycoprotein E (gpE) of Japanese encephalitis virus (JEV) on the JEV-infected mice was studied. The MAbs were characterized as hemagglutination-inhibition-positive and JEV-specific (Hs). In the protective experiment, mice were first administered single MAbs or their combinations intraperitoneally (i.p.) and 24 hrs later infected with the virus intracerebrally (i.c.). The results showed that single MAbs protected the mice to the extent of 45-65%, while combinations of two or three MAbs gave 85-90% or 100% protection, respectively. The enhanced effect of combinations of several Hs MAbs might be due to the sharing of neutralization epitopes recognized by the Hs MAbs. These results suggested that a combination of at least three epitopes represented by the Hs MAbs should be included in an effective JEV vaccine.

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[Primary mucosal melanoma of the sinonasal tract: report of 18 patients and analysis of 1077 patients in the literature].
Journal: Brazilian journal of otorhinolaryngology
September/29/2011
Description

The present study aimed at reporting on the characteristics, prognostic factors and treatment outcomes of 18 cases of nasosinusal mucosa melanoma, and do a literature review on the subject.

METHODS

between 1995 and 2005, 18 patients consecutively diagnosed with nasosinusal mucosa melanoma were managed in our institution. We reviewed the literature in PubMed and Scopus in order to find the main series from studies associated with this topic. We found a total of 35 series, involving 1,077 patients with nasosinusal mucosa melanoma.

RESULTS

we found 16 men and 2 women, with age at presentation between 51 and 80 years (median of 58 years). All these patients were submitted to surgical excision followed by radiotherapy with or without chemotherapy. The survival median was 15 months, and the 5-year general survival had a percentage value of 23%. Considering our univariate analysis: tumor staging and complete remission after initial treatment were deemed relevant prognostic factors. Nonetheless, considering the multivariate analysis, only disease stage was statistically significant.

CONCLUSIONS

nasosinusal melanoma is a rare and aggressive tumor, with high loco-regional and distant failure rates, and poor treatment outcomes. Notwithstanding, in a literature review we found significant improvements considering the 5-year survival for recent series when compared to previously reported ones.

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The velcro mustache: a potential barrier to effective bag-and-mask ventilation in neonates on nasal cpap: two case reports.
Journal: Respiratory care
September/26/2011
Description

Hudson prongs (Hudson RCI, Teleflex Medical, Research Triangle Park, North Carolina) (a device to deliver nasal continuous positive airway pressure) are often secured with a "Velcro mustache" in neonatal intensive care units. We report 2 premature infants who required bag-and-mask ventilation while on Hudson prongs secured with a Velcro mustache. Effective ventilation was achieved only after removing the Velcro mustache.

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Molecular characterization of the RNA-dependent RNA polymerase from groundnut ringspot virus (genus Tospovirus, family Bunyaviridae).
Journal: Archives of virology
September/26/2011
Description

Groundnut ringspot virus is a negative-sense single-stranded RNA virus that belongs to the genus Tospovirus and is the prevalent member of this genus in Brazil. This work presents the nucleotide sequence of the L RNA, with a single open reading frame of 2873 amino acids in the complementary strand corresponding to the RNA-dependent RNA polymerase (L protein), as well as the characterization of conserved domains of the L protein by in silico analysis. Phylogenetic analysis of different L protein domains confirmed that GRSV is a member of the American clade, and comparison with a N-protein indicates that phylogeny based on L protein sequences may be more reliable than that based on the N protein.

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Complex regional pain syndrome in an 8-year-old female with emotional stress during deployment of a family member.
Journal: Military medicine
September/21/2011
Description

BACKGROUND

This pediatric case of complex regional pain syndrome (CRPS) illustrates the need to expand the typical age range and raise awareness of the psychological impact military deployment may have on its development.

METHODS

An emotional 8-year-old female, with a recently deployed father, presented with left foot pain. Over an 11-week-period, she developed symptoms, signs, and radiologic findings consistent with CRPS.

CONCLUSIONS

Pediatric CRPS is characterized by ecchymosis, edema, allodynia, mottling, and abnormal hair growth in the region of pain after minor trauma. It occurs predominately in adolescent females, mainly affects the lower limbs, and is associated with psychological stressors. This patient with CRPS presents several years younger than what is commonly described in the literature in the stressful setting of a deployed parent.

CONCLUSIONS

CRPS can occur in younger than expected age ranges of children who experience the unique emotional stressor of a deployed family member.

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Basilar artery occlusion presenting as a tonic-clonic seizure.
Journal: The Israel Medical Association journal : IMAJ
September/21/2011
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