RESUMO
We present a case of benign exertional headache (BEH) in a 15-yr-old boy. The patient suffered from exclusively exercise-induced headaches with migraine-like accompanying symptoms. No pathology could be detected by routine cardiovascular or neurological examinations by CT. The postexercise 99mTc-HMPAO brain SPECT performed during the provoked headache attack showed asymmetric bifrontal hypoperfusion. A second 99mTc-HMPAO study during a symptom-free phase under resting conditions was normal. The detection of impaired regional cerebral blood flow (rCBF) by 99mTc-HMPAO brain SPECT indicates a perfusion-related pathology in this type of headache. Analysis of rCBF with 99mTc-HMPAO in larger studies could be helpful in the clarification of BEH pathogenesis.
Assuntos
Encéfalo/diagnóstico por imagem , Circulação Cerebrovascular/fisiologia , Cefaleia/diagnóstico por imagem , Compostos de Organotecnécio , Oximas , Esforço Físico , Tomografia Computadorizada de Emissão de Fóton Único , Adolescente , Cefaleia/etiologia , Cefaleia/fisiopatologia , Humanos , Masculino , Corrida , Tecnécio Tc 99m ExametazimaRESUMO
Intravenous drug-users comprise a major group of HIV-infected individuals in the developed world and, whilst progression of HIV disease in them appears little different from other risk groups, their medical presentations may be altered by continuing drug use. Drug-users are particularly susceptible to bacterial infections irrespective of their HIV status; they may present with symptoms directly caused by their drugs, which can be difficult to differentiate from non-drug-related causes and may closely resemble symptoms directly attributable to HIV. In addition, the life style associated with drug use can make compliance difficult, but in clinics combining HIV care and methadone prescribing these problems can be overcome.
Assuntos
Infecções por HIV/terapia , Abuso de Substâncias por Via Intravenosa/complicações , Feminino , Infecções por HIV/complicações , Humanos , Masculino , Cooperação do PacienteRESUMO
A 67-yr-old woman with a history of myocardial infarct was admitted to emergency for marked dyspnea, nonproductive cough, nausea and fever. The thorax X-ray revealed a bilateral alveolar and interstitial infiltration pattern with basal accentuation. The cardiac examinations were normal. Technegas ventilation and Tc-99m-macroaggregated albumin (MAA) perfusion scans were performed to rule out pulmonary embolism. Bilateral multiple ventilation defects with normal perfusion was observed. The patient had been taking nitrofurantoin for four days for a bladder infection. Hypersensitivity to nitrofurantoin was suspected and the drug was discontinued. An antihistaminic and anxiolytic medication was started. The majority of the clinical symptoms disappeared within 24 hours. The control chest X-rays disclosed a marked improvement. Ventilation and perfusion scans obtained 48 hours after nitrofurantoin withdrawal were normal. The drug-related pulmonary reactions should be taken into account in patients on medication. Reversible ventilation defects can be the only lung-scintigraphic finding encountered in acute pulmonary nitrofurantoin reaction.
Assuntos
Anti-Infecciosos Urinários/efeitos adversos , Pulmão/efeitos dos fármacos , Nitrofurantoína/efeitos adversos , Ventilação Pulmonar/efeitos dos fármacos , Idoso , Anti-Infecciosos Urinários/farmacologia , Feminino , Humanos , Pulmão/diagnóstico por imagem , Nitrofurantoína/farmacologia , Radiografia , Cintilografia , Relação Ventilação-Perfusão/efeitos dos fármacos , Raios XAssuntos
Divertículo Ileal/diagnóstico por imagem , Estômago/diagnóstico por imagem , Adolescente , Cateterismo/efeitos adversos , Dilatação Patológica/diagnóstico por imagem , Humanos , Falência Renal Crônica/terapia , Masculino , Melena/diagnóstico por imagem , Diálise Peritoneal , Cintilografia , Pertecnetato Tc 99m de Sódio , Estômago/patologiaRESUMO
OBJECTIVE: We aimed to assess the nature and patterns of psychiatric disorders among adolescents who had been war-abducted in the war in northern Uganda, compared to non-abducted adolescents living in Gulu district, Uganda. METHOD: A cros sectional study that used an unmatched case-control design compared 82 abducted and 71 non-abducted adolescents for scores on measures of psychological distress and for selected psychiatric diagnoses using the Strength and Difficulties Questionnaire (SDQ) and the Mini International Neural-Psychiatric Interview for Children and Adolescents English version 2.0 (M.I.N.I-KID). RESULTS: More than 90% of adolescents reported exposure to severe trauma, either through direct or indirect experiences. Significantly more war abducted adolescents reported PTSD (26.8%v.12.7%) (p=0.03) major depression (19.5%v.4.2%) (p=0.004), and generalised anxiety disorder (13.4v.4.2%) (p=0.049) than non abducted adolescents. By contrast, non-abducted adolescents reported more past suicidality (p=0.004, chi(2)=8.2) than adolescents who were abducted. However, despite high rates of psychiatric disorder, these adolescents had good psychosocial adjustment. CONCLUSION: Adolescents in war affected areas whether warabducted or not have varied and clinically significant emotional responses to different kinds of traumatic exposure. In a war-affected area, the development of a sustainable service for adolescents that tries to address the full range of mental health problems may be more appropriate than a psychological trauma service that focuses on one diagnosis.