Pericarditis as a manifestation of essential thrombocythemia.

A 58-year-old woman presented with pericarditis and pericardial effusion. Investigation revealed that she was suffering from a thrombocythemic myeloproliferative disorder; she died of massive pulmonary embolism 10 days after admission. Histologic study verified epicardial and pericardial trilineage hematopoiesis. Pericarditis is an unusual feature of essential thrombocythemia and it may occur in direct relation to the abnormal cellular proliferation.     

Geophagia in horses: a short note on 13 cases

Recorded in several species including humans, geophagia or soil eating has been observed in both wild and domesticated horses and has generally been regarded as an indication of nutritional deficiency or "boredom". Studies of soils consumed by different species have led to several theories as to the identity of soil constituents that stimulate geophagia. In this study, geochemical analysis of 13 equine geophagic sites from different parts of Australia was undertaken. Significantly larger concentrations of iron and copper were found in soil samples from geophagic sites when compared to paired control samples, suggesting that these elements provide the stimulus for geophagia.     

Stress-induced cardiomyopathy

A 58-year-old female presented with typical chest pain, which had started a week ago. She presented late because she first suspected that her symptoms were due to severe stress related to the terminal illness of her father.     

Adaptation of a multicomponent treatment for irritable bowel syndrome to a small-group format

We evaluated a multicomponent treatment program for IBS that had been adapted to a small-group format. Patient acceptance was satisfactory with 14 of 17 potential patients completing treatment. No reductions of GI symptoms were noted in a 12-week symptom-monitoring baseline phase; diarrhea became significantly worse. Treatment led to significant (p less than .05) reductions in abdominal pain and diarrhea. Nine of 14 (64.3%) patients were clinically improved.     

Adaptation of a multicomponent treatment for irritable bowel syndrome to a small-group format

We evaluated a multicomponent treatment program for IBS that had been adapted to a small-group format. Patient acceptance was satisfactory with 14 of 17 potential patients completing treatment. No reductions of GI symptoms were noted in a 12-week symptom-monitoring baseline phase; diarrhea became significantly worse. Treatment led to significant (p<.05) reductions in abdominal pain and diarrhea. Nine of 14 (64.3%) patients were clinically improved.     

Transient nephrogenic diabetes insipidus associated with acute hepatic failure in pregnancy

A 29-year-old nullipara was admitted at 31 weeks' gestation because of toxemia. She noted gradually polyuria, severe thirst, malaise, nausea and anorexia. A water-deprivation test and administration of aqueous vasopressin confirmed the diagnosis of nephrogenic diabetes insipidus. At 33 weeks' gestation, blood chemistry studies revealed moderately elevated transaminase levels and hyperuricemia. Male twins were delivered by vacuum extraction at 35 weeks' gestation. After delivery, she became drousy and icterus appeared. Acute hepatic failure with marked hyperuricemia was diagnosed. She was treated with glucose solution with glucagon and soluble insulin, branched chain amino acids, gabexate mesilate, lactulose and famotidine. Her consciousness cleared rapidly and all laboratory data became normal by 15 days postpartum. The urine volume was about 5 liters per day from the first to sixth postpartum day. The diuresis decreased after the eighth postpartum day. Rare pregnancy complicated by transient nephrogenic diabetes insipidus and acute hepatic failure is discussed.     

多发性骨髓瘤并发上消化道侵袭性念珠菌病2例报道及文献复习

目的 探讨多发性骨髓瘤(Multiple myeloma,MM)并发上消化道侵袭性念珠菌病的临床特点,提高诊治该病的水平.方法 回顾分析我科2例多发性骨髓瘤并发上消化道侵袭性念珠菌病的诊治过程,分析、总结治疗经验,并结合文献复习骨髓瘤并发上消化道侵袭性念珠菌感染的易感因素、临床表现、诊断和鉴别诊断及治疗.结果 MM患者1,女性,异基因造血干细胞移植术后4个月发生腹泻伴腹部隐痛,抗移植物抗宿主病(graftversus host disease,GVHD)治疗无效,经胃镜诊断上消化道念珠菌病,予卡泊芬净治愈出院.MM患者2,男性,化疗过程中疾病进展,并出现腹胀、腹痛,对症处理改善,再次化疗时上述症状加重并发肺部念珠菌病,发生急性心、肾功能不全,经胃镜诊断上消化道念珠菌病,予伊曲康唑、米卡芬净治疗,最终因肺部真菌感染加重,治疗无效死亡.结论 多发性骨髓瘤并发上消化道侵袭性念珠菌病易发生误诊、漏诊.临床医生需提高对该病的认识,首选电子胃镜明确诊断、判断疗效.     

复方嗜酸乳杆菌片对感染性腹泻患者胃肠道症状的影响

目的应用复方嗜酸乳杆菌片治疗感染性腹泻,观察微生态制剂对患者胃肠道症状的影响。方法选择100例感染性腹泻患者,均来自青岛大学附属中心医院,采用随机数字表法随机分为A、B组。其中A组患者(80例)单用复方嗜酸乳杆菌片(1.0g/次,3次/d,口服)治疗;B组患者(20例)单用利福昔明片(0.2g/次,4次/d,口服)治疗。两组患者均采用配对设计方法,治疗前进行胃肠道症状分级评分,包括单个症状(腹痛、腹胀、腹泻频率、大便性状)的评分和上述症状的总评分。治疗3d后门诊随访或电话随访,再次进行胃肠道症状分级评分,比较治疗前后患者的胃肠道症状评分改善情况并判断疗效以及治疗中的不良反应。结果两组患者的总有效率分别为78.75%和85.00%,差异无统计学意义(P0.05)。两组患者治疗过程中均未见不良反应。复方嗜酸乳杆菌片治疗后患者腹胀、腹泻频率、大便性状的症状评分和症状总评分较治疗前显著降低,差异有统计学意义(P0.01)。腹痛症状评分治疗前后差异无统计学意义(P0.05)。结论复方嗜酸乳杆菌片治疗感染性腹泻能达到满意的疗效,可改善患者腹胀、腹泻频率、大便性状等胃肠道症状。     

Use of a long acting somatostatin analogue in controlling life threatening ileostomy diarrhoea.

A woman presented with persistent ileostomy diarrhoea unresponsive to conventional drug treatment and necessitating parenteral nutrition. Output was four to six litres of watery fluid per 24 hours while she was receiving oral nutrition and two to three litres when she was starved. Treatment with a long acting analogue of somatostatin (50 micrograms subcutaneously every 12 hours) reduced the ileostomy output to 2.0-2.5 litres/24 hours with an oral diet and the effluent became semiformed. Parenteral fluids could be stopped. Somatostatin may have a role in the treatment of secretory diarrhoea, but prospective controlled trials are necessary.     

Pheochromocytoma With Histologic Transformation to Composite Type,Complicated By Watery Diarrhea,Hypokalemia, and Achlorhydria Syndrome

ObjectiveTo describe the rare occurrence of histologic transformation of a pheochromocytoma to a composite type of tumor during a long-term follow-up, which was complicated by watery diarrhea, hypokalemia, and achlorhydria syndrome.MethodsWe report the case of a 12-year-old girl who presented with headache, hypertension, and elevated catecholamine levels in the blood and urine. A tumor was found in the right adrenal gland and resected. When she was 15 years of age, multiple metastatic nodules were found in the lung and liver. Intensive chemotherapy was ineffective, and she underwent follow-up with conservative therapy. At 25 years of age, she complained of diarrhea. Laboratory studies revealed hypokalemia and an increase in the level of serum vasoactive intestinal polypeptide (VIP). A year later, she died of extensive metastatic disease. The primary and recurrent tumors at autopsy were histologically examined.ResultsThe primary tumor was pure pheochromocytoma, and the tumors at autopsy were a composite type of pheochromocytoma and ganglioneuroma. Only a few VIP-positive cells were found in the primary tumor, whereas both pheochromocytoma and ganglioneuroma cells of composite tumors were frequently positive for VIP.ConclusionOur case showed histologic transformation from pheochromocytoma to a composite type of tumor during a 14-year clinical course, which was associated with additional hormone production and a change in symptoms. Careful attention should be paid to the alteration of endocrine symptoms and hormone levels during prolonged follow-up of pheochromocytoma in young patients. (Endocr Pract. 2012;18:e91-e96)     

Treating the abdominotorso region of the massive weight loss patient: an algorithmic approach

There has been tremendous growth in the number of patients seeking body contouring procedures after massive weight loss. Most patients desire improvement of the abdominotorso region first. After massive weight loss, there is enormous variability of body proportions, and therefore there have been many surgical options proposed based on the quality of the skin, subcutaneous fat component, and location of the lax tissue. Each area needs to be assessed to see whether there is a significant lower abdominal component, an upper midline abdominal component, or contributions from the buttocks and flanks. An algorithm for treatment is presented to simplify the decision-making process. Patient examples are also shown to demonstrate the usefulness of the algorithm.     

Perforated ascending colon cancer presenting as colocutaneous fistula with abscess to the anterior abdominal wall at the site of a cholecystectomy scar treated with biologic mesh

Ascending colon cancer as a colocutaneous fistula to the abdominal wall at the site of a previous postoperative scar is extremely rare. A 69 year old male presented with five day history of pain and foul smelling discharge from right subcostal scar from elective cholecystectomy performed 8 years ago. Last three days, he had fever up to 39 degrees C, with mild pain in right upper abdominal quadrant without vomiting, diarrhea, bloody stools or weight loss. Computed tomography, with peroral contrast, revealed extralumination into abdominal wall with several fistulas reaching the skin. Emergency median laparotomy found infiltrating tumor of ascending colon into abdominal wall. A right hemicolectomy and complete thickness abdominal wall excision (7 x 10 cm) was performed. The abdominal wall defect was too extensive for primary closure and two 20 x 20 cm moist gauzes were placed to cover the defect and were fixed with stitches to the skin. On second postoperative day, due to contamination, porcine dermal collagen implant was placed intraperitoneally. Such emergency presentations and therapeutic options are discussed.     

A case of pulmonary paragonimiasis with involvement of the abdominal muscle in a 9-year-old girl

In Korea, many people enjoy eating raw or underkooked freshwater crayfish and crabs which unfortunately may cause paragonimiasis. Here, we describe a case of pulmonary and abdominal paragonimiasis in a 9-year-old girl, who presented with a 1-month history of abdominal pain, especially in the right flank and the right inguinal area, with anorexia. A chest radiograph revealed pleural effusion in both lungs, and her abdominal sonography indicated an inflammatory lesion in the right psoas muscle. Peripheral blood analysis of the patient showed hypereosinophilia (66.0%) and an elevated total serum IgE level (>2,500 IU/ml). The pleural effusion tested by ELISA were also positive for antibodies against paragonimiasis. Her dietary history stated that she had ingested raw freshwater crab, 4 months previously. The diagnosis was pulmonary paragonimiasis accompanied by abdominal muscle involvement. She was improved after 5 cycles of praziquantel treatment and 2 times of pleural effusion drainage. In conclusion, herein, we report a case of pulmonary and abdominal paragonimiasis in a girl who presented with abdominal pain and tenderness in the inguinal area.     

Severe recurrent abdominal pain: an anatomical variant of Chilaiditi's syndrome

A patient who presented to the emergency department with severe, recurrent abdominal pain demonstrated Chilaiditi's sign, a radiographic term for interposition of the hepatic flexure of the colon between the liver and right hemidiaphragm. Workup of this clinical case revealed anomalous colonic anatomy, which led to successful laparoscopic corrective surgery. We call attention to the potential importance of this sign when associated with clinically recurrent abdominal pain (Chilaiditi's syndrome).     

LESS COMMONLY RECOGNIZED CLINICAL FEATURES OF AMEBIASIS

Among the less commonly recognized clinical manifestations of intestinal and hepatic amebiasis are vague abdominal distress in the absence of diarrhea, symptoms like those of peptic ulcer, and symptoms of a kind that may be ascribed to psychoneurosis. Hepatic amebiasis may be confused with other diseases affecting areas above or below the right diaphragm, such as cholecystitis, viral hepatitis, pneumonia or pleurisy.Adequate therapy in every case must include a course of a drug effective against hepatic involvement (chloroquine or emetine) and a drug effective against intestinal involvement (Diodoquin, Milibis, or carbarsone). Even in the absence of positive results of stool examinations, a course of antiamebic therapy is always justified as a diagnostic and therapeutic measure.     

Less commonly recognized clinical features of amebiasis

Among the less commonly recognized clinical manifestations of intestinal and hepatic amebiasis are vague abdominal distress in the absence of diarrhea, symptoms like those of peptic ulcer, and symptoms of a kind that may be ascribed to psychoneurosis. Hepatic amebiasis may be confused with other diseases affecting areas above or below the right diaphragm, such as cholecystitis, viral hepatitis, pneumonia or pleurisy. Adequate therapy in every case must include a course of a drug effective against hepatic involvement (chloroquine or emetine) and a drug effective against intestinal involvement (Diodoquin, Milibis, or carbarsone). Even in the absence of positive results of stool examinations, a course of antiamebic therapy is always justified as a diagnostic and therapeutic measure.     

Bleeding oesophageal varices and hepatic dysfunction in adult polycystic kidney disease.

A patient with adult polycystic liver and kidney disease presented with haematemesis and melaena and was found to have raised serum creatinine, aspartate transaminase, and alkaline phosphatase values; hypoalbuminaemia; and a prolonged prothrombin ratio. She also had oesophageal varices. With haemodialysis her aspartate transaminase activity fell to normal but she remained hypoalbuminaemic with a prolonged prothrombin ratio. She died after three weeks. Although hepatic cysts do occur in adult polycystic kidney disease, they have been thought not to cause major liver disease. The hepatic cysts in this patient, however, did appear to be associated with portal hypertension and impaired hepatocellular function.     

Pseudomembranous colitis associated with antibiotic therapy — an emerging entity

Two cases of pseudomembranous colitis are presented. The first patient had been treated with novobiocin-tetracycline and penicillin, and two weeks later developed severe fulminating diarrhea with ascites and bilateral pleural effusions which did not respond to intravenous ACTH. Subsequently she underwent subtotal colectomy and made a rapid and complete recovery. The second patient developed severe diarrhea two weeks after a 10-day course of clindamycin. She was treated with intravenous ACTH, oral Lactobacillus and a fecal enema and made a complete recovery.These cases reconfirm the importance of antibiotics as etiologic agents in this disease. They also stress the classic sigmoidoscopic and histologic findings that should facilitate prompt and rapid diagnosis.     

Development of impact factors on damage to health by infectious diseases caused by domestic water scarcity

Background, aim, and scope  

Water scarcity is a critical environmental issue. In particular, domestic water is a necessary resource for our fundamental activities, and poor water quality may lead to damage to health caused by infectious diseases. However, there is no methodology to assess the damage of domestic water scarcity (low accessibility to safe water) caused by water consumption. The main objectives of this study are to model the health damage assessment of infectious diseases (ascariasis, trichuriasis, hookworm disease, and diarrhea) caused by domestic water scarcity and calculate damage factors on a country scale.