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 170,190 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

An analysis was undertaken, for the first time, of the total picture of the medical disorders of adults on a small Caribbean island. At present non-infectious diseases, especially diabetes and hypertension, are of major improtance. Parasitic infestation of the gut occurred in 50-60% of the hospital population. The pattern of diseases indicates that the island is in a transitional stage of its medical development, and that resources need not be directed to the curative as well as to public health programmes. The impact of peculiarities of local geography and customs are discussed as contributing to some of the more unusual diseases of the Caribbean.
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PMID:Medical disorders in a small Caribbean island. An analysis of the disease of adults in Dominica in 1972 and 1973. 126 3

Urinary schistosomiasis presenting with the clinical signs of acute glomerulonephritis is described in 20 African children. Nineteen had oedema, 10 had circulatory overload, 11 had hypertension, 12 had oligoanuria and all had obstructive uropathy with hydronephrosis. Lack of support for a diagnosis of post-streptococcal glomerulonephritis (PSGN) was the absence in these patients of a raised anti-streptolysin 0 titre and marked reduction in C3, which are noted in about 93% of those with PSGN. Furthermore, casts were not detected in freshly voided urine. Six of these patients required peritoneal dialysis. Signs in 16 reverted to normal within 3 weeks and two children died. One child had severe interstitial fibrosis and dilated and atrophic tubules with normal glomeruli, and died 18 months later in renal failure; the other had disseminated schistosomiasis and focal areas of chronic inflammatory cells with fibrin thrombi in small vessels in the kidney and died 6 days after admission. Obstructive uropathy cleared within 4-12 weeks in all seven patients who were followed up. Preliminary findings in a few children suggest a non-glomerular origin for this disease: a tubulo-interstitial disorder secondary to obstructive uropathy seems the most likely cause of this clinical problem. As renal biopsies were not ethically indicated, it is not possible to exclude PSGN completely in all these children. This syndrome could have escaped notice and may have been interpreted as glomerulonephritis with associated bilharzia, and therefore may constitute a previously unrecognized complication of Schistosoma haematobium infestation.
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PMID:Acute obstructive urinary schistosomiasis mimicking clinical glomerulonephritis: an unrecognized syndrome. 248 1

Clinical and computerized tomography findings in patients with miliary infestation of cysticerci in brain parenchyma are presented. Cysticercotic encephalitis produces a severe and frequently fatal neurological disorder. Although parenchymal cysticercosis is common in endemic areas, in the cases reported here, the pathology is induced by a severe inflammatory response in brain parenchyma rather than by the physical presence of multiple cysts. As a result of diffuse brain edema, all cases develop subacute severe intracranial hypertension and compromise of visual function. One important feature of this form of neurocysticercosis is that it particularly affects young women.
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PMID:Cysticercotic encephalitis: a severe form in young females. 382 97

When larvae of C. sinensis reach the biliary system and mature, the flukes provoke pathological changes, both as a result of local trauma and of toxic irritation. The appearances vary with duration and severity of the infestation, but they are sufficiently distinctive and characteristic to allow a classification into four phases as follows; 1st phase, desquamation of epithelial cells, 2nd phase, hyperplasia and desquamation of epithelial cells, 3rd phase, hyperplasia and desquamation of epithelial cells, and adenomatous tissue formation, and 4th phase, marked proliferation of the periductal connective tissue with scattered abortive acini of epithelial cells and fibrosis of the wall of the bile duct. The onset of symptoms and signs is at times gradual, at times sudden. Chill and fever up to 40 degrees C occur during the acute stage, i.e. the period less than a month after parasite invasion. And a few weeks later, the chronic stage follows with the classical clinical features. In general, symptoms and signs can be classified as follows: mild, essentially symptomless, progressive, with irregular appetite, gastrointestinal disturbances, oedema, hepatomegaly, etc., and severe, with a syndrome associated with portal cirrhosis and hypertension. Pathogenic changes and complications are generally restricted to foci, but may eventually affect the whole liver. Calculi, acute suppurative cholangitis, recurrent pyogenic cholangitis, cholecystitis, hepatitis, and acute pancreatitis are important complications. Carcinoma of the liver is often found in association with clonorchiasis, too.
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PMID:Clonorchis sinensis: pathogenesis and clinical features of infection. 639 2

The cysticercosis is an infestation caused from the larva of Taenia solium, which is demoniated Cysticercus cellulosae. Infestation by the encysted forms occur within brain, muscle, cutis, eye and more rarely within kidney, liver, thyroid. The cysties cause inflammation, oedema and residual calcification. In the SNC they are responsible for seizures, usually of focal type, hydrocephalus, meningitis, endocranic hypertension, stroke. One case of neurocysticercosis in a 15 years old boy is described: the clinical pictures, the neuroradiologic images and the treatment are discussed.
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PMID:[Neurocysticercosis: a rare cause of convulsive crises]. 866 97

Neurocysticercosis is an important public health problem in South-Central American and South Asia. A review of the differences in epidemiological and clinical attributes of cysticercosis and taeniasis in South Central America and India, respectively, is undertaken in the present communication. Intestinal taeniasis is hyperendemic in several American countries. In comparison, the prevalence of Taenia solium infestation is lower in India. The clinical manifestations in several American neurocysticercosis series comprise epilepsy, intracranial hypertension and meningeal-racemose cysticercosis, in roughly equal proportions. An overwhelming majority of the Indian subjects present with seizures. The commonest pathological substrate of the disorder in Indian patients is the solitary parenchymal degenerating cyst. The reasons for the predominance of solitary forms in India, and of multilesional forms in South Central America are discussed. The magnitude of Taenia solium infestation and the frequency of pork consumption in a given population appear to influence the quantum of cyst load in affected individuals.
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PMID:Neurocysticercosos in South-Central America and the Indian subcontinent. A comparative evaluation. 962 48

The study covers a group of 100 asymptomatic blood donors (14 women and 86 men) with positive serological test for Chagas' disease. All of them were living in urban non endemic areas at the moment of the test, but before they had lived in endemic areas. Patients with coronary heart disease, congenital heart disease, hypertension, diabetes, alcoholism or thyroid disease were not included. The sample was split in two groups: Group I: 23 patients (aged 41.95 +/- 10.52) with evidence of myocardial involvement at physical examination, chest roentgenograms and/or EKG, that we considered inherent to Chagas cardiopathy; and Group II: 77 patients (aged 38.36 +/- 10.57) without abnormal findings. There were no significant differences between the two groups in age, sex, type of house in the endemic area and familial history of Chagas' disease. We found significant differences in the period of residence in endemic areas of Chagas' disease (Group I 21.26 years +/- 7.21 vs Group II: 15.56 years +/- 5.91; p = 0.0015). Additionally, patients in Group I were more frequently able to describe or recognize the transmitting insect than patients in group II (p = 0.05) and to accept the possibility of a triatomide bite (p = 0.024). In group I, more people were coming from Santiago del Estero province, an area with a large bug infection. The results of our research suggest that the myocar-dial damage in patients with positive serological test for Chagas' disease is more likely when there is a larger exposure to the transmitting insect, and when its infestation is larger. All of this, probably, as a consequence of incoulation reiterations.
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PMID:[Chagas disease in blood donors]. 967 90

Neurocysticercosis is the most frequently observed parasitosis of the central nervous system worldwide. The fourth ventricle is the most frequent site of intraventricular infestation, a location that carries a higher risk for CSF blockage and intracranial hypertension due to CSF blockage. A great number of patients become shunt dependent which carries a poorer prognosis. We report on a case of a patient with symptomatic obstructive hydrocephalus due to cysticercus in the fourth ventricle where an endoscopic approach via a frontal burr hole was performed. Although there is no consensus in the literature for the optimal treatment of this disease, this method seemed adequate for treatment of fourth ventricle cysticercosis in patients with hydrocephalus, aqueductal and foramen of Monro dilatations.
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PMID:Endoscopic approach to fourth ventricle cysticercosis. 1280 98

Rosacea is a common chronic dermatosis characterized by varying degrees of flushing, erythema, telangiectasia, edema, papules, pustules, ocular lesions, and phymas. Etiology and pathogenesis of rosacea are still unknown. Many possible causes have been described as inducing the disease or contributing to its manifestation, such as genetic predisposition, abnormal vascular reactivity, changes in vascular mediating mechanisms, Helicobacter pylori infection, Demodex folliculorum infestation, seborrhea, sunlight, hypertension, and psychogenic factors. However, none of these factors has been proved. Rosacea shows a wide spectrum of clinical presentations, which vary over time and with age. Successful management of rosacea requires careful patient evaluation and individualized therapy with appropriate variations and modifications, as the severity of the disorder fluctuates. In mild cases of rosacea, patients are instructed to avoid sun, to apply sun-protective creams, and to avoid facial irritants and other triggers that provoke symptoms. At later stage, drug therapy is often necessary. The disease commonly requires long-term treatment with topical or oral medicaments. Surgical correction may be required for rhinophyma and telangiectasia. We reviewed the current literature on the aspects of the pathogenesis, diagnostic criteria, and treatment options for rosacea.
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PMID:Etiopathogenesis, classification, and current trends in treatment of rosacea. 1467 Feb 25

Psychiatric manifestations are frequently associated with pernicious anemia including depression, mania, psychosis, dementia. We report a case of a patient with vitamin B12 deficiency, who has presented severe depression with delusion and Capgras' syndrome, delusion with lability of mood and hypomania successively, during a period of two Months. Case report - Mme V., a 64-Year-old woman, was admitted to the hospital because of confusion. She had no history of psychiatric problems. She had history of diabetes, hypertension and femoral prosthesis. The red blood count revealed a normocytosis with anemia (hemoglobin=11,4 g/dl). At admission she was uncooperative, disoriented in time and presented memory and attention impairment and sleep disorders. She seemed sad and older than her real age. Facial expression and spontaneous movements were reduced, her speech and movements were very slow. She had depressed mood, guilt complex, incurability and devaluation impressions. She had a Capgras' syndrome and delusion of persecution. Her neurologic examination, cerebral scanner and EEG were postponed because of uncooperation. Further investigations confirmed anemia (hemoglobin=11,4 g/dl) and revealed vitamin B12 deficiency (52 pmol/l) and normal folate level. Antibodies to parietal cells were positive in the serum and antibodies to intrinsic factor were negative. An iron deficiency was associated (serum iron=7 micromol/l; serum ferritin concentration=24 mg/l; serum transferrin concentration=3,16 g/l). This association explained normocytocis anemia. Thyroid function, hepatic and renal tests, glycemia, TP, TCA, VS, VDRL-TPHA were normal. Vitamin B12 replacement therapy was started with hydroxycobalamin 1 000 ng/day im for 10 days and iron replacement therapy. Her mental state improved dramatically within a few days. After one week of treatment the only remaining symptoms were lability of mood, delusion of persecution, Capgras' syndrome but disappeared totally 9 days after the beginning of the treatment. A neurologic examination was possible because of cooperation. All the tendon reflexes of inferior members were absent. The plantars were in flexion and there was a left inferior member hypoesthesia. The cerebral scan and EEG were normal. Fundic biopsy, realized by fibroscopy, revealed fundic atrophia and intestinal metaplasia compatible with Biermers' disease. The iron deficiency exploration concluded diet deficiency. Mme V. appeared euphoric, her speech was very rapid with play on words and overactivity. This hypomania state totally disappeared 3 days after. Six Months after her hospitalisation, she presented an hypothyroidism (TSH=3,780; T3=1,35; T4=1,08). A thyroid hormones replacement was started and she continued to receive Monthly B12 replacement. Discussion - This case report illustrates psychiatric manifestations of Biermers' disease. The clinical arguments in favour are: white woman, more than 60 Years old, no history of psychiatric problems, atypical symptoms (confusional state with psychiatric symptoms), fluctuation of symptoms (severe depression with confusional state, delusion of persecution and Capgras' syndrome; delusion with lability of mood and hypomania), dramatic improvement after 9 days of vitamin B12 replacement therapy. The biological arguments are: anemia, vitamin B12 deficiency, normal folate level, atrophia and fundic metaplasia, positive antibodies to parietal cells in the serum, association between Biermers' disease and autoimmune disease (Haschimoto thyroidite). Psychiatric manifestations can occur in the presence of low serum B12 levels but in the absence of the other well recognized neurological and haematological abnormalities of pernicious anemia. Mental or psychological changes may precede haematological signs by Months or Years. They can be the initial symptoms or the only ones. Verbank et al. described the case of a patient with vitamin B12 deficiency in whom hypomania, paranoia and depression had been successively presented during a period of 5 Years before anemia have been developed. The case of Mme V. is similar in the succession of severe depression with delusion of persecution and Capgras' syndrome, delusion with lability of mood and hypomania, during a period of two Months. This report seems to be the first one of a sequence of several psychiatric states with pernicious anemia during a period of two Months with normocytosis anemia. To illustrate this illness we reviewed the literature regarding psychopathology associated with B12 deficiency. The most common psychiatric symptoms were depression, mania, psychotic symptoms, cognitive impairment and obsessive compulsive disorder. The neuropsychiatric severity by vitamin B12 deficiency and the therapeutic efficacy depends on the duration of signs and symptoms. Conclusion - We recommend consideration of B12 deficiency and serum B12 determinations in all the patients with organic mental disorders, atypical psychiatric symptoms and fluctuation of symptomatology. B12 levels should be evaluated with treatment resistant depressive disorders, dementia, psychosis or risk factors for malnutrition such as alcoholism or advancing age associated with neurological symptoms, anemia, malabsorption, gastrointestinal surgery, parasite infestation or strict vegetarian diet. In first intention, B12 deficiency should be researched by serum B12 determination (normal 200-950 pg/ml). Studies of methylmalonic acid and homocysteine showed that they are very sensitive functional indicators of cobalamin status especially when other evidence of cobalamin (B12) deficiency was equivocal. Measurement of methylmalonic acid (normal 73-271 nmol/l) and homocysteine (normal 5,4-13,9 micromol/l) should not replace the measurement of serum cobalamin.
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PMID:[Psychiatric manifestations of vitamin B12 deficiency: a case report]. 1502 91


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