Infective Endocarditis Presented as Acute Pyelonephritis: A Case Report

ABSTRACT Infective endocarditis is less likely to sparkle out preferentially in our minds when evaluating and making differential diagnosis of patients with fever daily in emergency departments. We describe a case of infective endocarditis. He was initially diagnosed with pyelonephritis of the right kidney at a hospital because of the noted right flank knocking pain. His computed tomography showed two wedge-shaped low-density lesions in the spleen and the right kidney separately. It dropped a hint to the emergency department physician of thinking of the feature of infarct. The previously neglected cardiac murmurs were then an important clue. We then performed transthoracic emergent echocardiography and confirmed the diagnosis of infective endocarditis.

Evaluation of salivary function by sialoscintigraphy in locally advanced nasopharyngeal cancer patients after intensity modulated radiotherapy.

PURPOSE: This study aimed to evaluate the salivary gland function changes by sialoscintigraphy in locally advanced nasopharyngeal cancer (NPC) after intensity modulated radiotherapy (IMRT). MATERIALS AND METHODS: Salivary function was assessed by sialoscintigraphy. Quantitative sialoscintigraphy was performed in 24 NPC patients prior to and after IMRT. Results were categorized in four groups according to the duration of treatment. The sialoscintigraphy parameters were examined. RESULTS: Sialoscintigraphy showed a significant difference in the secretion of each interval groups. The parameters of scintigraphy, except maximum accumulation (MA) of submandibular glands, decreased first after radiotherapy, and then recovered. However, the MA of submandibular glands was continuously downhill after radiation. CONCLUSIONS: The sialoscintigraphy parameters of each gland changed with the different radiation dose and follow‑up intervals. The salivary function was influenced after radiotherapy in locally advanced NPC, especially, in the submandibular gland. Strategies to improve the salivary function should be assessed.

Prognosticators and the relationship of depression and quality of life in head and neck cancer.

Background and Purpose: To evaluate the relationship of emotional status and health-related quality of life (HRQOL) in disease-free head and neck cancer (HNC) patients post treatment and to explore their predictive factors. Materials and Methods: Seventy-three HNC patients, post treatment at least 1 year, were recruited to complete three questionnaires, EORTC QLQ-C30, EORTC-H&N35 cancer module, and the Beck Depression Inventory-II (BDI-II). Results: Patients with depression demonstrated significantly poor global health status/QoL (score 41.7 vs. 71.9, P<0.001) and almost all functioning, except for role functioning. Besides, depressive patients presented statistically significant worse symptoms in all QLQ-C30 items, except constipation and financial problems, and in all QLQ-H&N35 symptoms except for teeth and coughing problems. Depression was significantly negative correlated with all functional scales and global health status/QoL (r = -0.341 to -0.750, all P<0.05), and was significantly positive correlated with symptom scales (r = 0.348 to 0.793, all P<0.05), except for constipation. Stepwise multiple linear regression analyses showed that physical functioning and physical distressful symptoms play an important role in the perception of HRQOL (total 46% explained). Global health status and impaired social functioning could explain depression in addition to emotional functioning (total 64% explained). Conclusions: HNC patients with depression were noted to have poorer HRQOL in almost every functioning symptom. HNC patients may get benefit from early interventions to improve HRQOL, emotional status, or both by a more rapid and friendly questionnaire to earlier identify patients with poor HRQOL or depressive status.

Trastornos cardiovasculares en pacientes con malformaciones somaticos turnerianas. / Cardiovascular disorders in patients with Turner's somatic malformations

Se investigaron los trastornos cardiovasculares en 81 pacientes con malformaciones somaticas turnerianas; 68 de ellos eran portadores de un sindrome de Turner y 13 de un sindrome de Noonan. El 7,3% de los pacientes con sindrome de Turner presentaron alteraciones cardiovasculares; tres de ellos hipertension arterial idiopatica (4, 4%) y dos estenosis aortica (2,9%), se hallaron alteraciones electrocardiograficas en 18/63 casos restantes (28,6%), que en 17 consistio en trastornos de la conduccion y en uno fue hipertrofia ventricular izquierda. En el 30,8% de los pacientes con sindrome de Noonan se hallaron alteraciones cardiovasculares; dos de ellos tenian estenosis pulmonar y dos comunicacion interventricular. En 2/9 casos restantes se observo hipertrofia ventricular izquierda en el electrocardiograma. Los resultados de este estudio demuestran la alta frecuencia de anomalias cardiovasculares en el sindrome de Noonan con respecto al sindrome de Turner, y ademas sugieren que los trastornos cardiovasculares son diferentes en estos dos sindromes. El examen cardiovascular puede ayudar al diagnostico diferencial de estas dos enfermedades

Una nueva prueba para el diagnostico de la diabetes insipida. / New test for the diagnosis of diabetes insipidus

Se utilizo la carbamazepina en una nueva prueba para el diagnostico de la diabetes insipida parcial o incompleta.La prueba se basa en la accion antidiuretica rapida y potente del medicamento cuando hay secrecion de ADH endogena. El estudio se realizo en nueve pacientes con diabetes insipida vasopresin sensible (dos de causa organica y el resto idiopaticos) y en tres con polidipsia psicogenica. Se hallo respuesta antidiuretica practicamente en todos los casos, lo que demuestra que el deficit parcial de ADH es mucho mas frecuente que el total, y que la carbamazepina puede disminuir la diuresis en la polidipsia psicogenica. Durante la prueba pueden presentarse sitnomas de sobrehidratacion, por el aumento de la accion hormonal mientras se mantiene una ingestion aumentada de liquidos, en especial en los pacientes con potomania y en los que presentan diabetes insipida de causa organica. Los resultados demuestran que la prueba propuesta permite el reconocimiento de la diabetes insipida parcial e incompleta, aun en medio con escasos recursos tecnicos y que su aplicacion facilitara el estudio del sindrome poliurico-polidipsico