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Query: UMLS:C0018681 (headache)
 56,091 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Lupus erythematosus (LE) is an autoimmune disorder, involving the skin and/or other internal organs. As cutaneous variants, chronic discoid LE (CDLE) and subacute cutaneous LE (SCLE) usually have a better prognosis, however, involvement of internal organs with transition into systemic disease may occur. The aim of this study was to assess the significance of some clinical and laboratory criteria that could serve as markers for early recognition of systemic involvement in cutaneous LE. Three hundred and seventy-nine patients with LE, seen in five cooperating Departments of Dermatology during the years 1989-1994, were documented by electronic data processing according to a common protocol. Two hundred and forty-five of these patients had cutaneous LE (CDLE or SCLE), and 51 had systemic LE (SLE) and were included in this study. Forty-nine patients with either CDLE/SCLE or SLE were not evaluated because of incomplete documentation; also, 34 patients suffered from other LE subsets and were likewise excluded from the evaluation. Multivariate statistical analysis was used to assess the value of seven selected variables for distinguishing between the CDLE/SCLE and SLE groups: ESR, titers of antinuclear antibodies, anti-dsDNA-antibodies, photosensitivity, presence of arthralgias, recurrent headaches and signs of nephropathy. Univariate and multivariate analysis of the obtained data showed that signs of nephropathy (proteinuria, hematuria) was the variable with the highest statistical relevance for distinguishing between patients with cutaneous (CDLE/SCLE) and with systemic LE (SLE) in all statistical models tested, followed by the presence of arthralgias and of high ANA titers (> or =1:320). In contrast, low ANA titers as well as anti-dsDNA antibodies showed little or no statistical relevance as a criterion for distinction. It seems, therefore, that cutaneous LE patients showing signs of nephropathy, presence of arthralgias and elevated ANA titers (> or =1:320) should be carefully monitored, because they may be at risk of developing systemic LE involvement.
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PMID:Markers in cutaneous lupus erythematosus indicating systemic involvement. A multicenter study on 296 patients. 922 25

We describe a Chinese American family with a hereditary syndrome consisting of retinopathy, nephropathy, and stroke, affecting 11 members spanning three generations. Ophthalmologic evaluations revealed macular edema with capillary dropout and perifoveal microangiopathic telangiectases. Several members had renal abnormalities with proteinuria and hematuria. Initial manifestations were visual impairment and renal dysfunction; neurologic deficits occurred in the third or fourth decade of life. Symptoms included migraine-like headache, psychiatric disturbance, dysarthria, hemiparesis, and apraxia. Neuroimaging consistently demonstrated contrast-enhancing subcortical lesions with surrounding edema. Ultrastructural studies showed distinctive multilaminated vascular basement membranes in the brain and in other tissues, including the kidney, stomach, appendix, omentum, and skin. Genetic analysis ruled out linkage to the CADASIL locus on chromosome 19. Distinct from CADASIL, hereditary endotheliopathy with retinopathy, nephropathy, and stroke (HERNS) is an autosomal dominant multi-infarct syndrome with systemic involvement.
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PMID:Hereditary endotheliopathy with retinopathy, nephropathy, and stroke (HERNS). 937 16

Herpes infections continue to be prevalent, especially in immunocompromised patients. Some of these patients will develop resistant HSV infections. Therefore, it is important to explore new treatment options. Animal studies have shown cidofovir to be effective in the treatment and prevention of HSV infections. Human data are limited, with only one randomized, double-blind, placebo-controlled trial performed to date. The results from this study look promising; however, due to the small sample size, a larger clinical trial is warranted. The human data available as case reports are suboptimal in the quality of reporting time frames for resolution of lesions/symptoms and outcomes of therapy. Another problem with the case report data is that the TK status of the herpes simplex isolates was not reported. This would have helped substantiate the acyclovir resistance seen in these patients. It was evident in these case reports that acyclovir resistance can be overcome, as acyclovir-resistant strains became sensitive following cidofovir therapy. This may be because TK(+) viruses have been shown to establish latency more readily than do TK(-) viruses. This pattern suggests that alternating between acyclovir and cidofovir therapies may provide a strategy to manage the emergence of alternatively acyclovir-sensitive and -resistant infections. At present, only the intravenous formulation of cidofovir is commercially available. Advantages of the intravenous formulation include weekly dosing and efficacy. Disadvantages are the complexity of administration and the adverse effect profile. The most common adverse effects with this formulation include nephrotoxicity manifested as proteinuria (12%), and increased creatinine (5%) and neutropenia (15%). Administration of probenecid and NaCl 0.9% hydration are used to reduce the incidence and severity of nephrotoxicity in patients who are receiving cidofovir. Probenecid also has toxicities, including nausea, vomiting, headache, fever, and flushing. The topical formulation of cidofovir looks promising for mucocutaneous HSV infection because it is usually undetectable in the blood following topical administration. Therefore, systemic adverse effects should be minimized. A cidofovir gel product (Forvade, Gilead Sciences) is currently being reviewed by the Food and Drug Administration for the treatment of refractory HSV. Ultimately, more controlled clinical studies are necessary to determine whether routine cidofovir use can be justified in patients with acyclovir-resistant HSV infection.
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PMID:Cidofovir use in acyclovir-resistant herpes infection. 941 91

Nine days after working in the woods, a previously healthy 32-year-old man fell seriously ill. His symptoms included high fever, chills, diffuse myalgia, severe headache, and back pain. On the fifth day of onset of symptoms, blood tests showed creatinine levels of 5.4 mg/dL accompanied by marked proteinuria. After admission to the hospital, a diagnosis of nephropathia epidemica (NE) caused by Puumala virus was made using solid-phase enzyme-linked immunosorbent assay (ELISA). The patient gradually recovered renal function without requiring dialysis. However, he surprisingly experienced a sharp decline in platelet count to a minimum of 2,000/microL with concomitant occurrence of petechiae and conjunctival hemorrhage. Prednisolone was initiated, resulting in a swift rise in platelets. Six days later, when the medication was withdrawn, a sharp decrease in platelets recurred. The steroids were then readministered for the next 3 months, thus reestablishing a stable platelet count. The immediate rise of platelets after administration of prednisolone supports the pathophysiological view of hantavirus infection as an immunologically mediated disease. Corticosteroids in the treatment of hantavirus-associated thrombocytopenia might need further systematic evaluation.
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PMID:Severe thrombocytopenia and response to corticosteroids in a case of nephropathia epidemica. 942 61

A 26-year-old woman with twin fetuses of 28 weeks' gestational age had symptoms of preeclampsia and was admitted to the hospital for observation. Nine days later, after reporting a severe headache, the patient experienced loss of vision in both eyes. An emergency computed tomographic brain scan was performed to rule out intracranial hemorrhage, and cesarean delivery was performed. Twelve hours after the operation, the patient's vision improved gradually and returned to normal after 24 hours. The placenta was submitted to pathologic examination, and magnetic resonance imaging was performed 4 days after birth. Recent thrombosis observed in the histologic section of the placenta, ischemic changes in the brain seen in the computed tomographic and magnetic resonance scans, and severe proteinuria manifested clinically suggest vascular endothelial damage as the underlying mechanism in this case of preeclampsia-related transient cortical blindness.
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PMID:Transient cortical blindness in preeclampsia with indication of generalized vascular endothelial damage. 973 96

One hundred and four adult cases of cerebral malaria (73 male, 31 female) were studied between July 1995 to June 1996 in Chittagong Medical College Hospital. Diagnosis of cerebral malaria was based on unrousable coma or any neurological manifestation in a febrile patient with asexual Plasmodium falciparum in blood film. Intermittent fever (83%), vomiting (80%), headache (75%), convulsion (60%) and history of travel or residence in malaria endemic area were important features noted in patients with cerebral malaria. Most of the patients (69%) were admitted within 25 to 48 hours following unconsciousness. The factors are more common in cases with high mortality with diastolic blood pressure (DBP) below 60 mm of Hg, anaemia, persistence of Glasgow Coma Score below 5 on day 2, high parasite count at presentation, proteinuria and high level of serum urea. Out of 104 cases of cerebral malaria 66 patients (63.5%) recovered without sequelae, 34 patients (32.7%) died and 4 patients (3.8%) recovered with some residual sequelae. Establishment of intensive care unit in tertiary level hospitals is necessary to take appropriate measure for severe cerebral malaria cases for reduction of mortality.
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PMID:Cerebral malaria--a study of 104 cases. 992 81

A 36-year-old woman, at the 17th week +5 days gestational age, who was already admitted to the nephrology department for gestational hypertension, proteinuria and legs oedema, was admitted to our Institute. About three weeks before her admission to the nephrology dept., the patient presented heart palpitations and exertional dyspnoea related to the first evidence of the legs oedema, weight gain (about 5 kg during only one month) and normal blood pressure values. During the following days, an antihypertensive therapy was made, but hypertensive crisis and strong headache were also persistent. Vulvar oedema was observed, the uterus was moderately contracted and its dimensions were similar to an uterus at the 21st week; beta-hCG serum values were more than 500,000 IU/lt. An echography confirmed the diagnostic suspicion of hydatidiform the presence of a fetus developed as much as the gestational time. beta-hCG serum values increased to 1,200,000 IU/lt; the molar abortion induction was made thru prostaglandins: fetal extrusion occurred after three hours. The placenta was instrumentally extracted and it showed evident hydatidiform moles a uterine curettage. Patient temperature was very high (39 degrees C) in the immediate postoperative period and three hematologic pockets were transfused. After a week, we made a second elective uterine curettage with the extraction of a little quantity of gestational material; the patient was still hospitalised for ten days: during this time there was a progressive decrease of the beta-hCG serum values (last value at discharge: 7,200 IU/lt). The patient had also positive beta-hCG serum values after about one year.
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PMID:[Partial hydatidiform mmole at the 17th week of pregnancy]. 1023 Feb 45

Hantavirus disease is a recently recognised zoonosis. The main vectors are infected but healthy wild rodents or laboratory rats. Transmission to man occurs via contact with, or inhalation of aerosolised excretions. The target organs in man are the kidney (Old World) or the lung (New World), probably via a local hyperproduction of pro-inflammatory cytokines. To date, more than 33 different hantaviruses have been characterised, at least 14 of them being of clinical importance. Each serotype has its own rodent vector and its own geographical spread. In Europe, the red bank vole (Clethrionomys glareolus) is the main rodent vector, carrying the Puumala (PUU) serotype, which is the etiologic agent of a viral affection known as Nephropathia epidemica (NE). PUU infection has been recognised for the first time in Belgium in 1983. From this date on, approximately 500 cases have been diagnosed. In our regions, a diagnosis of hantavirus disease is mandatory when a febrile patient presents with lumbaches, headache, and an acute renal failure with proteinuria, and particularly with thrombocytopenia.
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PMID:[Hantavirus infections in Belgium]. 1065 77

A cadaveric kidney transplant recipient, with no history of a connective tissue disease, was admitted with malaise, arthralgias, diplopia, mild headache, and a painful left eye. The patient was on maintenance immunosuppression for 14 years with cyclosporine and methylprednisolone. Initial laboratory data indicated an elevated serum creatinine from baseline, 2+ proteinuria, and 50 to 100 red blood cells (RBCs)/high-power field (HPF) in the urine. Renal biopsy was consistent with necrotizing vasculitis involving glomerular capillaries, with crescent formation and an absence of immune complexes. Perinuclear antineutrophil cytoplasmic autoantibodies (P-ANCA) and anti-myeloperoxidase (MPO) were found to be elevated. To the best of our knowledge, this is the first reported case of an ANCA-associated small vessel vasculitis (SVV) developing in a renal transplant recipient without history of connective tissue disease.
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PMID:De novo ANCA-associated vasculitis occurring 14 years after kidney transplantation. 1069 95

Description of a black widow spider (Latrodectus mactans) envenomation in a term pregnancy.Case report conducted at an Air Force tertiary care hospital of a 27-year-old primigravida at 38 1/7 weeks pregnancy.Latrodectus mactans antivenin can be given to treat symptoms of black widow envenomation.Black widow envenomations can cause symptoms associated with acute intra-abdominal processes. In pregnancy, envenomations can result in symptoms and signs similar to those seen in preeclampsia (abdominal pain, headache, hypertension, and proteinuria). Latrodectism should be considered in patients complaining of these symptoms in association with a spider bite. If latrodectism is considered to be the underlying origin for these symptoms, appropriate treatment should be administered. In cases of pregnancy, treatment should include L. mactans antivenin if believed to be clinically indicated. There is no current evidence that this antivenin is contraindicated in pregnancy. (Curr Surg 57:346-348)
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PMID:Black widow spider (Latrodectus mactans) envenomation in a term pregnancy. 1102 47


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