Successful Early Treatment Research Articles

A full-term infant with large patent ductus arteriosus successfully closed with oral ibuprofen: a case report

Background: Ductus arteriosus is a vascular shunt between the aorta and pulmonary artery. Within the first 24-48 hours of life, the ductus usually closes. Failure of closure is called patent ductus arteriosus (PDA). Timing for treatment is crucial. Early treatment can decrease the need for drugs or surgery, but it can cause more adverse events, such as brain hemorrhage, bowel perforation and renal dysfunction. On the other hand, late treatment can cause complications such as pulmonary hemorrhage, necrotizing enterocolitis and can render drugs to be less effective. Case Presentation: The patient was a 2 hours old male, 39 weeks, Apgar 7/8, 3100 grams, referred to the cardiology team because of tachypnea and peripheral cyanosis. Initial echocardiographic showed large patent ductus arteriosus, coarctation aorta, patent foramen ovale and moderate tricuspid regurgitation. The patient was given 60mg of oral ibuprofen for the first day and 30mg of oral ibuprofen for the second and third days. In addition, the patient was given 2mg of furosemide, 2.5mg of spironolactone and 12.5mcg of digoxin twice daily to prevent heart failure. Echocardiographic evaluation after three days showed closure of large patent ductus arteriosus, no mild preductal coarctation aorta remains, trivial tricuspid and patent foramen ovale. No side effects were observed. Conclusion: This case showed successful early treatment of large PDA in full-term infants with a double dose of oral ibuprofen. Adverse events were not found. As a result, Ibuprofen should be considered as an early treatment for PDA in full-term infants.

Non-invasive cancer detection in canine urine through Caenorhabditis elegans chemotaxis.

Cancer is the leading cause of death in companion animals, and successful early treatment has been a challenge in the veterinary field. We have developed the Non-Invasive Cancer Screening (N.C.S.) Study to perform cancer detection through the analysis of canine urine samples. The test makes use of the strong olfactory system of the nematode Caenorhabditis elegans, which was previously shown to positively respond to urine samples from human cancer patients. We performed a proof-of-concept study to optimize the detection capability in urine samples obtained from dogs with naturally occurring cancers. In this study, we established a scale for identifying the cancer risk based on the magnitude of the chemotaxis index of C. elegans toward a canine urine sample. Through validation, the N.C.S. Study achieved a sensitivity of 85%, showing that it is highly sensitive to indicate the presence of cancer across multiple types of common canine cancers. The test also showed a 90% specificity to cancer samples, indicating a low rate of over-identifying cancer risk. From these results, we have demonstrated the ability to perform low-cost, non-invasive cancer detection in companion animals—a method that can increase the ability to perform cancer diagnosis and treatment.

The New FA₂ST Stroke Screening Score: An Expanding Recognition to Posterior Circulation Stroke

Background: Rapid screening and intervention are the keys to successful early treatment of stroke. Generally, the conventional FAST stroke screening score has been used by triage nurses to promptly detect acute stroke. However, the conventional FAST score has a limitation in detecting posterior circulation stroke, which results in high mortality rates. Previous studies have shown that adding ataxia could increase the sensitivity of posterior circulation stroke detection. Objective: To introduce and evaluate the diagnostic performance of a new stroke screening score, FA₂ST score, by adding ataxia to the conventional FAST score. Materials and Methods: The present study was a cross-sectional study. The new FA₂ST and conventional FAST scores were used by triage nurses in patients presented with acute neurological symptoms within seven days at the emergency department of three different types of hospitals in Thailand. Patients with Glasgow Coma Score less than 9 and those having unstable vital signs were excluded. Final diagnosis was made by a neurologist using clinical and neuroimaging information. The diagnostic performance of the new FA₂ST score was calculated using ROC curve in comparison to the conventional FAST score. The rate of posterior circulation stroke detection was calculated as percentage. Results: One hundred forty-six patients were studied. Of these, 127 (86%) had acute ischemic stroke and 19 (14%) had other diagnoses. The overall diagnostic performance of the new FA₂ST score was not statistically different with conventional FAST score in terms of area under the curve (0.642 versus 0.684, p=0.221). However, after in-depth analysis, the rate of posterior circulation stroke detection of the new FA₂ST score was higher compared with the conventional FAST score (94.12% versus 82.35%). Conclusion: The present study introduces the new FA₂ST stroke screening score and emphasizes the importance of posterior circulation stroke detection in acute stroke screening. Future studies should be considered before implementation of this score. Keywords: Screening score; Acute stroke treatment; Stroke; Emergency neurology

Successful Early Treatment of Severe Neonatal Hyperparathyroidism With Cinacalcet

Introduction: Neonatal severe hyperaparathyroidism (NSHPT) can cause significant bone disease early in life and prompt treatment is therefore necessary. Cinacalcet is a calcimimetic primarily used in adult patients with hypercalcemia to treat secondary hyperparathyroidism, but has only been trialed in neonates with NSHPT. Successful treatment appears to be dependent on the mutation leading to hypercalcemia. We describe a neonate born with severe hypercalcemia and a suspected mutation of the calcium sensing receptor (CaSR) who received successful early treatment with cinacalcet and decrease in calcium levels.Case Report: A full-term baby girl was found to have rapid breathing at 2.5 hours of life requiring CPAP. A chest x-ray demonstrated bone demineralization with rib fractures. Lab evaluation demonstrated hypercalcemia (total calcium = 12 mg/dl) with an inappropriately elevated PTH level of 386 pg/mL, hypophosphatemia (3.3 mg/dL), normal magnesium (2.0 mg/dL), a normal urine calcium to creatinine ratio of 0.26 and calcium to creatinine clearance ratio of 0.05 and a slightly low vitamin D-25 of 28.8 ng/mL.The father had a history of asymptomatic hypercalcemia without a diagnosis. Paternal genetic testing identified a heterozygous pathogenic CASR defect: c. 554G>A (p.Arg185Gln). This has been described in patients with NSHPT.The patient was initially treated with IV fluids and Lasix, but calcium levels did not decrease. Cinacalcet therapy was given on day of life 10. Patient had a decreased PTH to 231 pg/ mL after one day. After 26 days of treatment, patient’s PTH level decreased to 63 pg/mL. Patient was weaned off of CPAP and was discharged home.Discussion: Cinacalcet, a calcimimetic that works at the level of the CASR, was able to successfully and significantly decrease PTH levels in a neonate patient with NSHPT. Treatment options are limited in patients with this condition and we believe prompt treatment with this therapy facilitated patient’s discharge. The patient’s osteopenia secondary to the NSHPT and subsequent rib fractures resulted in a prolonged requirement of CPAP. Early recognition and treatment, even prior to results of genetic testing, prevented further fractures. We demonstrate the potential benefit of calcimimetics in a case of NSHPT where conventional treatment was ineffective. More importantly, we anticipate improvement in osteopenia and any future comorbidities secondary to this condition. Continued success with this treatment is yet to be evaluated.

Successful early treatment with intravenous immunoglobulin for seronegative myasthenia gravis with onset during pregnancy: A case report

AbstractMyasthenia gravis is an autoimmune disorder predominantly affecting women of reproductive age; its course during pregnancy is unpredictable. Here we report a case of a 34‐year‐old woman who developed myasthenia gravis during pregnancy. At 18 weeks of pregnancy, she started experiencing general fatigue and weakness when working. After examination, we diagnosed her with seronegative myasthenia gravis. Treatment included pyridostigmine (60 mg/day), oral prednisolone (5 mg, alternate day), intravenous immunoglobulin (0.4 mg/kg/day, 5 days) and methylprednisolone pulse therapy (500 mg/day, 3 days); her clinical response was good.An uneventful vaginal delivery took place and the infant showed no signs of muscular weakness. Myasthenia gravis is a high‐risk disease, particularly when associated with pregnancy. We suggest that early treatment with intravenous immunoglobulin is safe and effective for myasthenia gravis with pregnancy.

Cutaneous paraneoplastic disorders in stomach cancer: Collaboration between oncologically active dermatologists and clinical oncologists.

To our knowledge this is the first systemic review that provides an overview of the cutaneous paraneoplastic syndromes (CPS) (i.e., clinical manifestations, pathomechanisms, and treatment modalities) occurring in stomach cancer. CPS are caused by substances produced by stomach cancer and may precede, coincide with, or follow the diagnosis of this malignancy. More than 20 possible CPS in association with stomach cancer have been identified. CPS mostly compromises the patient's quality of life by skin impairment plus discomfort and are often associated with a dismal prognosis on survival. Studies of these CPS not only in stomach cancer have partially contributed to the understanding of pathomechanism and since CPS may be the presenting sign of an occult cancer, cognizance of their features and clinical implications are of considerable importance. Patients with these syndromes should have an appropriate work-up for a possibly occult malignancy with consecutive successful early treatment.

Comparison of two methods of early treatment in developmental dislocation of the hips

Objective To compare the early treatment results of Pavlik harness and closed reduction plus spica casting in treating developmental dislocation of the hips (DDH). Methods The patients with Graf Ⅲ/Ⅳ type DDH diagnosed by ultrasound in our hospital were analyzed retrospectively from January 2009 to December 2013. The subjects with intact clinical and radiologic data and more than 2 years follow-up were included. The present study included 257 patients (298 hips), 31 male and 226 female, with the average age of 74.1±39.2 d (from 30 to 159 d). Pavlik harness underwent in 190, while 67 cases were treated with closed reduction plus spica casting. Acetabular index (AI), Wiberg OE angle (point O was the middle point of proximal metaphyseal border) and Smith instability index (SI, SI-c: the lateral displacement index, SI-h: the vertical displacement index) on the pelvic X-ray film at 2-3 years of age after successful early treatment were recorded. Femoral head avascular necrosis (AVN) was diagnosed according to the Salter criteria. Results The success rate of reduction of closed reduction was significantly higher than Pavlik harness (97.5% vs. 69.9%, χ2=0.353,P=0.000). There was no significant difference in the incidence of AVN between the closed reduction and Pavlik harness (6.6% vs. 4.6%, χ2=0.106,P=0.745). For Graf Ⅲ type DDH, the success rate of reduction of Pavlik harness and closed reduction were 80.7% and 98.4% respectively (χ2=11.248,P=0.001), while the Pavlik harness group had significantly worse results of AI, OE and SI-c at the age of 2-3 years (Pavlik harness: 22.9°±3.7°, 16.5°± 6.3° and 0.74±0.06; closed reduction: 21.4°±3.4°, 18.9°±3.6° and 0.72±0.03;P<0.05). For Graf Ⅳ type DDH, the success rate of reduction of Pavlik harness was much less than closed reduction (25.6% vs. 94.4%, χ2=24.231,P=0.001), with significantly worse results of OE at the age of 2-3 years (16.0°±4.1° vs. 18.6°±4.5°,t=-2.141,P=0.038). Conclusion Pavlik harness has limitations in treating Graf Ⅲ/Ⅳ type DDH, with lower success rate of reduction for Graf Ⅳ type DDH. Closed reduction plus spica casting has better clinical results than Pavlik harness in success rate of reduction and subsequent hip development without the additional risk of AVN. Key words: Hip dislocation, congenital; Bone diseases,developmental; Orthopedic fixation devices

Successful early treatment in a case of Cogan's syndrome

We report a 53-year-old male with Cogan's syndrome. He was admitted to our hospital because of a fever of 2-weeks duration, blurred vision for 10 days, hypoacusis, and numbness of the left hand for 3 days. In addition to uveitis, hypoacusis, and aseptic meningitis, multiple mononeuropathy was diagnosed based on a nerve conduction study. Furthermore, positron emission tomography/computed tomography (PET/CT) revealed diffuse aortitis. Accordingly, the patient was diagnosed with Cogan's syndrome. After starting steroid-pulse therapy followed by 1 mg oral prednisolone/kg/day, the uveitis and hypoacusis improved immediately, while the peripheral neuropathy persisted until effectively treated with intravenous gamma globulin therapy. Prompt steroid therapy for Cogan's syndrome based on a diagnosis made using PET/CT prevented progression of the hypoacusis.

Successful Early Treatment of Boerhaave's Syndrome by Endoscopic Placement of a Temporary Self-Expandable Plastic Stent Without Fluoroscopy

Spontaneous rupture of the esophagus caused by vigorous vomiting (Boerhaave's syndrome) is a rare but life-threatening condition that usually requires immediate surgical treatment. Endoscopic treatment with positioning of a temporary covered stent is emerging as a challenging but viable treatment option, although the number of reported cases is small.1–6 Unfortunately, metallic stents, including those that are covered, are prone to ingrowth of hyperplastic mucosa. Successful removal of the stent can be extremely difficult and is often followed by secondary esophageal stricture formation. The type of stent to use under these circumstances and the correct timing for stent removal are controversial issues related to this technique. A case ofsuccessful endoscopic treatment of Boerhaave's syndrome by temporary placement of a new esophageal self-expanding, totally covered, plastic stent without development of hyperplasia or esophageal stricture after stent removal is reported.

EARLY WRIST ARTHRODESIS FOR IRREPARABLE INTRA-ARTICULAR DISTAL RADIAL FRACTURES

When articular restoration and congruity cannot be accomplished in distal radial fractures owing to severe articular bone loss or comminution, early wrist arthrodesis should be considered. This procedure rapidly restores wrist alignment and stability and controls pain. Arthrodesis is a highly reliable and definitive procedure that optimises the opportunity for early functional and occupational recovery while minimising the risks of developing stiff digits or chronic pain in injuries otherwise doomed from the start of treatment to result in severe wrist stiffness and post-traumatic arthritis. Simultaneous proximal row carpectomy or the use of ipsilateral local bone graft donor sites, such as the distal radius or proximal ulna, decrease both initial treatment and hospital costs and morbidity. Wrist arthrodesis is also effective when polytrauma or multiple fractures co-exist. Successful early treatment may expedite return to work and reduce lost time and wages resulting from the injury.

Clinical studies in suspected hip dysplasia or dislocation

Exact and sensitive clinical screening during the neonatal period allows detection of a majority of hip dysplasia and dislocations. Roser-Ortolani-Barlow maneuver promotes early detection of dislocatable hips and therefore opens the perspective for a successful early treatment. Ultrasound allows a good differentiation of suspected clinical abnormalities.

Treatment of recurrent ischemia after thrombolysis and successful reperfusion for acute myocardial infarction: Effect on in-hospital mortality and left ventricular function

To determine the effect of treatment of recurrent ischemia after reperfusion for acute myocardial infarction on in-hospital mortality and left ventricular function recovery and to identify patients at highest risk of serious consequences in the event of recurrent ischemia in this setting, 405 consecutively treated patients were studied retrospectively. All patients received intravenous thrombolytic therapy within 6 h of ST segment elevation-documented infarction and had angiographic confirmation of their reperfusion status performed within 120 min of treatment. Three hundred three patients had successful reperfusion with or without rescue angioplasty and had no recurrent ischemia (group 1), 74 patients had initially successful reperfusion but subsequent recurrent ischemia (group 2) and 28 patients had failed reperfusion (group 3). The in-hospital mortality in groups 1 to 3 was 2.0%, 14.9% and 32.1%, respectively (p less than 0.001) and the change from baseline to prehospital discharge left ventricular ejection fraction was 1.2 +/- 9.3%, -0.8 +/- 8.7% and -4.3 +/- 5.3%, respectively (p = NS). Within the recurrent ischemia group (group 2), multiple regression analysis found absence of cardiogenic shock at presentation (p = 0.002) and successful treatment initiated within 90 min of recurrent ischemia (p = 0.045) to be the only variables independently correlated with in-hospital survival. Later successful reperfusion was not associated with improved hospital survival. The timing and success of treatment did not affect recovery of global or regional left ventricular function in the patients with paired angiographic studies.(ABSTRACT TRUNCATED AT 250 WORDS)

Acute Hematogenous Osteomyelitis Complicating Closed Fractures

Five cases of acute hematogenous osteomyelitis occurring at the site of closed fractures are reported. This is a serious and potentially lethal complication resulting in directly in the death of 3 of the 5 patients. This is an unusual occurrence seen infrequently, and subsequent delay in diagnosis is frequent. An awareness of this complication (which usually occurs in the face of decreased resistance to infection) coupled with careful inspection of the fracture site, evaluation of the patient as a whole, and a high index of suspicion will allow earlier diagnosis and possibly more successful early treatment. Because of the pathophysiology of this lesion and the usual delay in diagnosis, initial treatment should include wide surgical drainage of the abscess with proper debridement and bony resection. This may involve procedures which at first glance may appear to be mutilating. In these patients with decreased resistance to infection, the initial appropriate choice of antibiotics is essential.

ACUTE MITRAL INCOMPETENCE AFTER ACUTE MYOCARDIAL INFARCTION, WITH SUCCESSFUL EARLY TREATMENT BY MITRAL-VALVE PROSTHESIS

ACUTE MITRAL INCOMPETENCE AFTER ACUTE MYOCARDIAL INFARCTION, WITH SUCCESSFUL EARLY TREATMENT BY MITRAL-VALVE PROSTHESIS

SUCCESSFUL EARLY TREATMENT OF SUBADVENTITIAL RUPTURE OF THE THORACIC AORTA.

TRAUMATIC rupture of the aorta has remained largely a pathological curiosity seen on postmortem examination of accident victims. Despite the lucid interval that is often present between injury and death successful operations have heretofore been limited to the late treatment of posttraumatic aneurysms. Successful early treatment depends on an awareness of the possibility of this condition in any serious injury and the interpretation of serial radiographs of the chest in that light. Operation should only be undertaken with a pump available so that a bypass from the left atrium to the femoral or iliac artery can be established . . .

Successful Early Treatment of a Vesico-Vaginal Fistula

Successful Early Treatment of a Vesico-Vaginal Fistula