European journal of medical research
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To evaluate the efficacy of chemosensitivity-testing directed chemotherapy in comparison with empirically chosen therapy regimens in patients with malignant melanoma stage IV. ⋯ Chemosensitivity-assay directed therapy might be a useful tool in determining the optimized chemotherapeutic drug or drug combination in the individual patient and might contribute to a better prognosis in patients with metastatic melanoma stage IV.
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Recent studies of patients with botulism found ophthalmoplegia as a characteristic clinical sign. Here we illustrate a very rare case of atypical foodborne botulism with multiple bilateral cranial nerve palsies sparing palsy of extraocular muscles. Therefore, the classical diagnostic pentad of botulism (dry mouth, nausea, vomiting, dysphagia, diplopia, fixed dilated pupils) may be of limited sensitivity in single cases.
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Case Reports
Inguinal hernia vs. arthritis of the hip in sporting adolescents--case report and review of the literature.
Chronic pain in the hip, groin or thigh can be caused by a wide spectrum of diseases posing extended diagnostic problems. We describe the case of a 10-years old child with chronic pain in the groin with gait restriction for more than six months without successful classification and treatment. The girl suffered from heavy pain in the groin after a sporting contest which forced her to walk with walking sticks and to avoid climbing stairs. Within six months she was examined by pediatric, orthopedic, pediatric surgery, pediatric orthopedic, radiology, pediatric rheumatology specialists. Working diagnoses were transient synovitis (coxitis fugax), arthritis, streptococcal arthritis, Morbus Perthes, rheumatic fever, rheumatoid arthritis. She was treated with antibiotics and ibuprofen in high dosage. Repeated laboratory tests and imaging studies (ultrasound, x-rays, magnetic resonance imaging) of the hip and pelvis did not support any of these diagnoses. Six months after beginning of the complaints the girl was presented by her mother to our institution. The physical examination showed a sharp localized pain in the groin, just in the region of the inguinal ligament with otherwise free hip movement. There was no visible inguinal hernia. The family history for hernia was positive. After infiltration of the ilioinguinal nerve the girl had a complete long-lasting disappearance of pain and gait disturbance. This led to the diagnosis of inguinal hernia with nerve entrapment. After hernia repair and neurolysis/neurectomy there was a continuous state of disappearance of pain and gait disturbances. ⋯ To avoid such a diagnostic dilemma one should always discuss all possible causes. Non-visible inguinal hernia may be more common in females than previously thought. Nerve entrapment as a cause of groin pain has been well described. The relationship of the start of complaints with sporting activity, a positive family history for inguinal hernia, a lack of signs of inflammation and bone involvement in the laboratory and imaging studies together with a localized pain in the groin, almost immediate long-lasting disappearance of pain after infiltration of the ilioinguinal nerve allowing free motion leads to the diagnosis of inguinal hernia with nerve entrapment. Hernia repair and neurolysis are the adequate treatment avoiding unnecessary radiation.
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Randomized Controlled Trial Clinical Trial
Effectiveness of a topical salve (Dynexan) on pain sensitivity and early wound healing following nonsurgical periodontal therapy.
The purpose of the present study was to evaluate clinically the effect of an anaesthetic gel (lidocaine 20 mg/g as active agent) on pain sensitivity and early wound healing following nonsurgical periodontal therapy. A total of 40 patients with chronic periodontitis were enrolled in this randomized, split-mouth, double-blind, placebo-controlled clinical trial. Each subject had 3 sites in each of 2 contra-lateral jaw quadrants with a probing pocket depth (PPD) of > or = 5 mm and bleeding on probing (BOP+). ⋯ In terms of wound healing no differences were found between the test and control sites after 1 week. The results of the study showed that the anaesthetic gel was statistically more effective than the placebo in reducing pain following nonsurgical periodontal therapy. However, in terms of early wound healing no significant differences were seen between the two treatment sites.
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Studies suggest that highly active anti-retroviral therapy (HAART) prolongs life in HIV infected individuals and that HIV infected individuals increasingly suffer from cardiovascular complications. NT-proBNP has been shown to represent an indicator of cardiac function. ⋯ HIV infected individuals had higher NT-proBNP levels than age matched blood donors possibly as a result of a higher prevalence of general cardiovascular risk factors and HIV associated risk factors, the finding is consistent with an increased incidence of cardiovascular events described in HIV infected individuals. Further studies on the relationship to cardiovascular outcome are warranted.