The American journal of the medical sciences
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Review Case Reports
Prognostically important molecular markers in cytogenetically normal acute myeloid leukemia.
Cytogenetically normal acute myeloid leukemia (CN-AML) is a heterogeneous disease with variable clinical outcomes. Emerging data has identified molecular markers that provide additional prognostic information to better classify these patients into those with a more favorable prognosis and those with an unfavorable prognosis who may require more aggressive or investigational therapies. ⋯ In this article, the authors discuss the classical clinical features of AML and the importance of cytogenetics that predict prognosis in AML. They review the best-described molecular markers in CN-AML and their significance to clinical decision making in CN-AML.
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Diaphragmatic hernias caused or exacerbated by colonoscopy are rare with only few cases reported. The author reports here an unusual case of herniation and incarceration of the colon into the left thoracic cavity without bowel perforation after an uneventful screening colonoscopy, through an occult focal diaphragmatic weakness from the patient's prior trauma.
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Multicenter Study
Epidemiology of spondyloarthropathies in Central America.
The authors reviewed retrospectively a cohort of 233 spondyloarthropathy patients observed in 2 centers in Guatemala City, Guatemala, and in hospitals in San Salvador, El Salvador, and San José, Costa Rica. Guatemalan patients were either from the clinic of Guatemalan Association against Rheumatic Diseases (n = 105) or from the private clinic of AGK (n = 78). El Salvador patients (n = 17) were from Hospital Instituto Salvadoreño del Seguro Social, and Costa Rican patients (n = 33) were from Hospital Calderón Guardia, San José, Costa Rica. ⋯ Prevalence of spondyloarthropathy was slightly higher in females than males (57% versus 43%, respectively). The median age was 47.5 years. Most of our patients were diagnosed with reactive arthritis or undifferentiated arthritis (47% and 33%, respectively); 10% of patients had ankylosing spondylitis and 9% psoriatic arthritis.
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Critical illnesses continue to be major causes of morbidity and mortality worldwide. Recent investigations show that stem cells may be beneficial as prognostic biomarkers and novel therapeutic strategies in these syndromes. This article reviews the use of stem cells in sepsis and acute lung injury as prognostic biomarkers and also as a potential for exogenous cell-based therapy. ⋯ Stem cells have shown significant promise in the field of critical care medicine both for prognostication and treatment strategies. Although recent studies have been done to describe the mechanistic pathways of stem cells in critical illness, further investigation is necessary to fully delineate the mechanisms behind a stem cell's immunomodulatory characteristics and its ability to mobilize and engraft in tissues.
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During the period of 2006 to 2007, 28 university centers in Brazil used a standardized protocol of investigation to study the epidemiological, clinical and radiological variables of 1036 consecutive patients with the diagnosis of spondyloarthritis (SpA). Validated translated (Portuguese) versions of the Bath Ankylosing Spondylitis (AS) Disease Activity Index and the Bath AS Functional Index were applied. Patient diagnoses were predominantly AS (72.3%), followed by psoriatic arthritis (13.7%), undifferentiated SpA (6.3%), reactive arthritis (3.6%), juvenile SpA (3.1%) and arthritis related to inflammatory bowel disease (1.0%). ⋯ Pure axial disease was observed in 36.7% of the patients, whereas the mixed pattern (axial, peripheral and entheseal) was observed in 47.9%. The most common extra-articular involvement was anterior uveitis (20.2%). HLA-B27 was positive in 69.5% of the tested patients.