Pattern Of Disease In Patients Research Articles

Analysis of Disease Patterns in Patients with Unilateral Sinonasal Diseases

Background/Purpose. To elucidate the clinical characteristics of patients with unilateral sinonasal diseases in Taiwan. Methods. A descriptive analysis of the clinical manifestations, and the clinical pathology, microbiology, and radiography results in 54 patients with computed tomography (CT)-documented unilateral sinonasal opacification who underwent endoscopic sinus surgery from August 2004 to July 2005. The severity of opacification was based on the Lund-Mackay scoring system. Results. Nasal obstruction, rhinorrhea, and postnasal drip were the most commonly observed clinical presentations. The presence of extranasal symptoms, such as facial numbness and visual complications, was suggestive of fungal sinusitis or neoplasm. More than 60% of the patients had chronic rhinosinusitis with or without polyposis. Staphylococcus was the most common pathogen (56%) encountered, and 22% of patients had fungal sinusitis caused by Aspergillus. Bacteriology revealed the existence of resistance to first-line antibiotics. There was a significant correlation between nasal septal deviation and ipsilateral sinusitis (p＜0.05). The average Lund-Mackay grading score was 6.4±2.0. Conclusion. The most common postoperative diagnosis of unilateral sinonasal diseases was chronic rhinosinusitis. Nasal septal deviation was an important factor for ipsilateral sinusitis. Staphylococcus was the most common pathogen causing unilateral sinonasal disease. A notable degree of resistance to first-line antibiotics was observed.

The pattern of metastatic disease in patients with pleural effusions secondary to breast cancer.

The pattern of pleural metastases in women with effusions secondary to breast cancer was evaluated by thoracoscopy in a series of 46 patients with previously untreated effusions. Metastases involving the visceral pleural were seen in 59 per cent of patients whereas parietal deposits were found in only 15 per cent. No tumour deposits were seen in 26 per cent of cases. No patients had both visceral and parietal tumour secondaries. Patients within each of these groups showed differences in rates of positive effusion cytology, chest wall recurrence and previous evidence of recurrent breast cancer.

Radiologic appearance of recurrent ileal Crohn disease

Postoperative recurrence of Crohn disease is a common problem. It has been assumed that the radiologic patterns are similar in de novo and recurrent ileal disease, but there has been little in the literature to actually confirm this belief. We retrospectively reviewed the small bowel examinations of 105 consecutive patients with a proven diagnosis of Crohn disease: a control group of 47 patients with no prior surgery and a postoperative group of 58 patients with resections. Of the latter, 22 had ileocecal or ileocolonic resections and 36 patients had ileocecal or ileocolonic and extensive enteric resections. We examined the disease sites and compared the disease patterns in both groups. Fifty-six of 58 (97%) postoperative patients had anastomotic recurrences with proximal extension from 3 to 25 cm, with a mean of 10.5 cm; none showed distal disease extension. Two (3%) had enteric recurrences with neoterminal ileal sparing. There were no statistically significant differences in the length of distal/terminal ileal disease and the frequency of skip lesions in de novo and recurrent disease. There were lower frequencies of mucosal thickening, ulceration/ulceronodular mucosa, sacculation, loop separation, sinuses, and masses and a higher frequency of strictures in recurrent disease than in de novo disease. There was also a lower frequency of ulceration or ulceronodular mucosa after extensive resection than after limited resection. Postoperative patients with ileal Crohn disease show a marked preponderance for anastomotic recurrence with proximal disease extension. There are significant differences in disease patterns in patients with de novo and recurrent disease.

Severity and Pattern of Coronary Artery Disease in Patients with Cardiovascular Dysmetabolic Syndrome

A cross-sectional study was carried out in the Department of Cardiology, Bangabandhu Sheikh Mujib Medical University, Dhaka in collaboration with Department of Cardiology, CMH, Dhaka Cantonment from June 1999 to May 2000. The patients clinically diagnosed or documented to have coronary artery disease (CAD) requiring coronary angiography (CAG) were included in the study, and were grouped into patients with Cardiovascular Dysmetabalic Syndrome (CDS Group) and without CDS (non-CDS group). The CDS was diagnosed by using the diagnostic criteria defined by Western Working Group, Hawaii, in 1997, Patients with hypertrophic and dilated cardiomyopathies, valvular and congenital heart diseases, and other systemic diseases were excluded frarn the study. OtherCAD risk factors, i,e. Smoking, family history of CAD and physical inactivity were also analyzed. The CAG findings were analyzed in terms of severity and pattern of coronary lesions and were compared between the groups.

Radiologic Pattern of Disease in Patients with Severe Acute Respiratory Syndrome: The Toronto Experience

Severe acute respiratory syndrome (SARS) is a transmissible febrile respiratory illness caused by a recently discovered coronavirus. Various patterns of disease progression may be observed that have different implications for the prognosis in those affected by SARS. The appearance of the lungs on chest radiographs of patients with this condition may be normal or may include focal airspace opacity or multifocal or diffuse opacities. Thoracic computed tomography (CT) is more sensitive in depicting SARS than is conventional chest radiography, and CT images obtained in patients with normal chest radiographs may show extensive disease and airspace consolidation. However, because the radiologic appearance of SARS is not distinct from that of other diseases that cause lower respiratory tract infection, early identification of SARS will depend in part on the prompt recognition of clusters of cases of febrile respiratory tract illness. To aid in the differential diagnosis and management of SARS, radiologists must be familiar with the typical clinical and histopathologic findings, as well as the radiologic features of the disease.

Prognostic significance of the radiographic pattern of disease in patients with severe acute respiratory syndrome.

This study was performed to evaluate the prognostic significance of the radiographic pattern of disease in probable cases of severe acute respiratory syndrome (SARS). A retrospective review of 439 radiographs was performed for 51 patients with a final diagnosis of probable SARS. Forty-nine patients were followed up for a mean interval of 23 days (range, 2-63 days). Abnormal findings on a chest radiograph were noted at presentation in 80.4% (41/51) of patients. Four radiographic patterns were seen: normal (group 1) in 19.6% (10/51), focal opacity (group 2) in 39.2% (20/51), multifocal opacities (group 3) in 27.5% (14/51), and diffuse air-space opacification (group 4) in 13.7% (7/51). Radiographic progression of disease occurred in 38.8% (19/49) of the patients in groups 1-4. There were no deaths in groups 1 and 2. In group 3, one (7.7%) of the 13 patients died. Five (71.4%) of the seven patients in group 4 died. Overall, 12.2% (6/49) of the patients died, all of whom had diffuse air-space opacification on the last chest radiograph. In these patients, medical comorbidity was present in 66.7% (4/6), and the exposure history was known in 83.3% (5/6). Death occurred at a mean interval of 18.2 days (range, 9-36 days) from the initial exposure. Patients presenting with normal findings or focal air-space opacity on chest radiographs had a good clinical outcome. Patients with multifocal opacities that progressed to diffuse air-space opacification and patients presenting with diffuse air-space opacification had a high fatality rate, but patients in this group were also older and more likely to have comorbid conditions. Patients with SARS present with recognizable patterns of disease that have prognostic significance.

Patterns of recurrence of bladder carcinoma following radical cystectomy

The purpose of this study was to describe the imaging features and patterns of disease in patients with recurrent bladder carcinoma following radical cystectomy.A retrospective review was made of the CT and MR findings in 42 patients (33 male, 9 female, mean age 65.1 years) with histologically verified transitional cell carcinoma of the bladder, who developed recurrent disease following radical cystectomy. Histology confirmed T2 disease in 7 patients, T3 disease in 26 patients and T4 disease in 9 patients. The tumour grade was G3 in 38 patients and G2 in 4 patients. The CT (n = 42) and MR imaging (n = 9) obtained at disease relapse were reviewed, noting the sites of disease recurrence and their imaging appearances.The mean time to recurrence following cystectomy was 14.6 months (range 2–50 months). Patients with T2 disease had a significantly longer time to recurrence compared with patients with T3 or T4 disease (22.7 vs. 13.0 months, student t-test, P < 0.05). The most common pattern of recurrence was pelvic lymphadenopathy (55%). Retroperitoneal lymphadenopathy was common (33%) and was the only site of nodal disease in 10%. Local pelvic recurrence (45%) appeared as a soft tissue mass, which involved muscle, urethra or vagina. Sites of distant metastasis included the liver (19%), bone (12%) and lungs (10%). Liver metastasis was associated with nodal disease in the majority (80%).The sites of recurrence of bladder cancer following radical cystectomy are described. Pelvic lymph node involvement is the most frequent site of disease recurrence despite the fact that pelvic lymph node dissection is performed as part of the standard procedure of radical cystectomy.

東洋医学と西洋医学を利用する患者の疾病行動分析

Health-related behavior and disease patterns of patients who were cured by either Oriental or Western Medicine were analyzed by a questionnaire survey data conducted on 455 patients in Seoul, Korea, October 1991. These objects were patients who consisted of 218 patients visiting with Oriental Hospitals (POH) and 237 patients in Western hospitals (PWH). The disease patterns of these two groups were significantly different. Diseases of patients who visited with POH were mainly diseases of the circulatory system (70.97%) and diseases of musculoskeletal system and connective tissue (11.14%), whereas diseases of PWH patients were occupied by diseases of the digestive system (10.35%), injury and poisoning fractures (11.67%), and also the circulatory system (10.88%) in the codes of ICD-9. As to comparisons in prevalence of diseases between POH and PWH, transient ischemic attack was prevalent in POH, and diabetes mellitus was dominant in PWH, even though cerebral embolism and hemorrhage were common in both. However, female and elderly patients visited more easily with POH than male and younger generations. It has been made clear that the threshold of visiting POH was independent from sociocultural attributes of residence, income, education, type of health insurance and religion. When this survey questioned also whether Korean Government should promote the integration of Oriental and Western Medicine in the medical policy, 67.8% of the POH patients and 54.9% of the PWH patients respectively agreed it.

Syndrome of severe skin disease, eosinophilia, and dermatopathic lymphadenopathy in patients with HTLV-II complicating human immunodeficiency virus infection

Two intravenous drug users dually infected with human immunodeficiency virus type 1 (HIV-1) and human T-cell leukemia virus type II (HTLV-II) developed an unusual severe dermatitis characterized by progressive brawny induration, fissuring, and ulceration of the skin, with an associated CD8 cell infiltration in one patient. Both patients had persistent eosinophilia. Lymph node biopsy revealed dermatopathic lymphadenopathy, an unusual pathologic finding in HIV-1 infection but one seen in association with mycosis fungoides and other skin disorders. Two new isolates of HTLV-II virus were established from these patients and were identified as HTLV-II by Southern blotting. This type of skin disease and lymph node pathology has not been found in other intravenous drug users who have been infected with HIV-1 alone or in patients in other risk groups for HIV-1 infection. HTLV-II may play a role in this unique new disease pattern in patients infected with HIV-1.

Changing disease patterns in patients with AIDS in a referral centre in the United Kingdom: the changing face of AIDS.

To study the changes in morbidity, mortality, and survival patterns in a population of patients with AIDS in the United Kingdom from 1982 to 1989. A retrospective analysis of inpatient and outpatient records of patients with AIDS. 347 Patients with AIDS, predominantly homosexual or bisexual men. Departments of immunology and genitourinary medicine, St Mary's Hospital, London. Presenting diagnosis of AIDS, occurrence of other opportunist diseases, cause of death, and survival since AIDS was diagnosed, in particular for those patients with Pneumocystis carinii pneumonia or Kaposi's sarcoma. The overall proportion of patients who developed P carinii pneumonia dropped from 56% (20/36) in 1984 to 24% (46/194) in 1989, although it has remained the index diagnosis in about half of new patients. Kaposi's sarcoma has decreased as index diagnosis from 30% (20/67) to 20% (15/74) over the same period, though the prevalence has remained constant at around 35%. P carinii pneumonia accounted for 46% (16/35) of known causes of death in 1986 but only 3% (1/31) in 1989. Conversely, deaths due to Kaposi's sarcoma rose from 14% (1/7) to 32% (10/31) between 1984 and 1989. Lymphoma accounted for an increased proportion of deaths among these patients with 16% (5/31) of deaths in 1989. Their median survival increased from 10 months in 1984-6 to 20 months in 1987. The changing patterns of disease in patients with AIDS have important implications both for health care provision and future medical research. Medical and nursing provision must be made for the increased morbidity of these diseases and the increased survival of these patients. Research should now be directed towards developing effective treatments for the opportunist infections which are currently more difficult to treat, the secondary malignancies of AIDS, as well as more effective immunorestorative treatments. Future changes in disease patterns must be recognised at an early stage so that resources can be adequately planned and allocated.